This article is based on a 2020 Healthcare Analytics Summit (HAS 20 Virtual) by Carrie Rys, MBA, Assistant Vice President, Ambulatory Operations, Texas Children’s Hospital, and Grace Karon, Assistant Director, Business Operations and Strategic Planning, Texas Children’s Hospital, titled, “Opening the Door for Patient Access: Growing Monthly Visit Volume by 27%.”
Improving patient access to healthcare has long been a common challenge for health systems. From understanding patient preferences about how to make appointments and meeting expectations, including wait times and travel distance for care, to decentralized referral processes, one of the most basic aspects of healthcare—getting patients access to their providers—has been a barrier to healthcare delivery and improvement.
In 2020, COVID-19 further challenged patient access with temporary halts on in-person primary and elective visits and patient-level challenges such as access to transportation and childcare and unpredictable employment circumstances. However, meeting pandemic-era patient access needs has allowed organizations to refine and ramp up their access strategies. By finding ways to get patients the care they need during COVID-19, health systems have identified long-term, scalable answers to persistent patient access challenges.
Health systems dedicated to connecting more patients with needed care at the right time and location can use a five-step framework for improving patient access.
The patient access task force must include representation from C-level leadership and leaders from across the organization. This structure encourages buy-in and championing from the top down, which builds the likelihood of widespread adoption and standardization of patient access improvement initiatives. Multidisciplinary engagement also ensures meeting different department needs (e.g., physician leaders represent clinical concerns), leveraging accessible solutions (e.g., IT leaders offer practical digital tools), and financial optimization.
Before the added complexity of COVID-19, patient access has been a pain point for patients and providers. Organizations can understand long-standing and pandemic-era access barriers within their populations and network through patient and provider surveys and interviews—either done in house or with a consulting firm.
Patient preferences and concerns health systems may want to learn about include the importance of ample, available appointment times; the ease (or difficulty) of making appointments by phone and online; how long patients are willing to wait for an appointment; and how far they’re ready to travel for care. Provider input may include differing referral preferences between clinics, confusing referral processes, inconsistent follow-up from the referred provider, and denied appointments.
While patient and provider challenges, expectations, and preferences will vary among organizations, a lot of health systems can use an understanding of barriers to patient access as opportunities for improvement. For example, COVID-19 made it harder for many patients to access in-person care, driving a significant shift to telemedicine. By increasing digital access, many organizations benefit from this shift by maintaining patient traffic (and associated revenue), while patients benefit with convenient access to care. Health systems are also learning that standardizing virtual care also patients overcome non-pandemic-era access barriers, such as finding transportation to appointments and aligning work and personal schedules with appointment times.
Additionally, patients often prefer booking appointments online versus over the phone and want to see a range of available appointment times during the scheduling process. Organizations may need to assess their online scheduling systems (Do they have one? How easy is it to find? Do patients see all the information they need?). Once the system has a viable scheduling portal, a simple solution, such as a “schedule now” button throughout the website, can help drive patients to needed services.
Steps 1 through 3 will inform an improved patient access plan, aligning the plan’s champions and leaders, identifying barriers and patient preferences, and targeting opportunities to better connect patients with care. Step 4 involves implementing the improved patient access plan. The implementation may comprise initiatives such as the following:
While organizations can use a stepwise framework to improve patient access, the work to better connect patients with care is ongoing. Health systems must prepare to scale and sustain access by adapting to current events (such as navigating COVID-19 with a more virtual, touchless experience), and ongoing community communication to understand patient needs and preferences.
Patient access has been one of the many areas of care delivery where COVID-19 has exposed existing gaps. While barriers to care—from reaching a clinic by phone to book a visit to finding available times that align with work and school schedules—are ongoing healthcare challenges, pandemic-era stay-at-home orders and freezes on elective care have forced many patients and providers to experience the real-world implications of deferred care. Meanwhile, COVID-19 has also driven a shift to virtual care, online scheduling, and more touchless steps in the delivery process. With a patient access improvement framework, organizations can work step-by-step to scale and sustain lessons learned and innovations made in access during the pandemic.
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