1

Navigating the complex world of patient access.

Triple Aim and the Access ImperativeJ.D. WHITLOCKVP, CLINICAL & BUSINESS INTELLIGENCEMERCY HEALTH

2

3

CMS Has Set Aggressive Goals for Transition to Value

Graphic: Premier Health Alliance

4

MACRA Reform Timeline(Medicare Access and CHIP Reauthorization Act of 2015)

Graphic: Premier Health Alliance

5

Access Story #1

6

Access Story #2

7

Access Story #3

8

HTTP://WWW.WIRED.COM/2015/04/UNITED-HEALTHCARE-TELEMEDICINE/

• Starting in 2016 United Healthcare will charge the same co-pay for a video visit or office visit

• Combined with “Minute Clinic” model, major potential for disruptive innovation

“Video is About to Become the Way We All Visit the Doctor”

9http://www.medicalpracticeinsider.com/news/your-patients-are-more-likely-switch-providers-you-think

80 percent of healthcare providers believe most patients depart due to relocation or change in insurance.

The reality is far different. Nearly 60 percent of patients switch physicians because of better service or treatment from a new provider.

10

A Catholic healthcare ministry serving Ohio and Kentucky

23 hospitals, 1,450 employed physicians, 32K employees

10th largest MSSP shared savings in 2014 275K lives between full risk and shared savings

contracts One of the larger single instance Epic customers Over 250 ambulatory practices certified HIMSS

Stage 7 #1 health plan for both Commercial and Medicare

products in Ohio (NCQA 2014 rankings)

11

“…the reasons for … disappointing performance lie in the impossibility of straddling two worlds with diametrically opposed incentives”

“These split incentives magnify organizational risks, not reduce them”

http://www.modernhealthcare.com/article/20150307/MAGAZINE/303079978

12

Oh By the Way … This is the Competition

13

MSSP 2014 CAHPS PerformanceQuestion / Aggregate Mercy MSSP

MeanGetting Timely Care, Appointments and Information 79.0 80.8

Getting Appointments for Urgent Care 88.3 87.1Getting Appointments for Routine Care 90.7 90.7Medical Question Answered Same Day 85.5 82.5Getting Seen Within 15 Minutes of Your Appointment 64.3 64.8

Courteous and Helpful Office Staff 92.4 91.7Between Visit Communication 56.5 60.1Care Coordination 87.6 86.9

How Well Providers Communicate 93.3 92.6Spending Enough Time With Patients 91.9 91.3Patient’s Rating of Provider 93.1 91.8Access to Specialists 85.0 84.1

14

“Amazing Patient Care” @ Mercy“Amazing patient care – Our three-year goal to make it easy for patients to get amazing care when they want it or need it has led to the formation of teams dedicated to strategies and tactics focused on access. Patients’ perception of access, as measured by the Press Ganey survey, will be the key indicator of our success.”

15

Access Initiatives @ Mercy1. Create a patient-centric, convenient, and visible

patient scheduling system Physician champion in each market Market level Access working group Standardize and improve Pre-Service Center functions

in all markets Standardize scheduling build and processes in Epic Streamline and simplify all PCP schedules

16

Access Initiatives @ Mercy2. Optimize technology to improve the patient

experience and access Enterprise call center with 24/7 nurse advice line and

appointment scheduling Migrate all practices to VOIP Expand functionality and use of Epic MyChart Install WiFi (for patients) in all practices Implement Epic CRM in all call centers Develop and implement comprehensive telemedicine

plan

17

Access Initiatives @ Mercy3. Measure, monitor, and communicate patient

access data with focus on the patient experience More emphasis on call center performance statistics Use scorecards to communicate performance and

progress Implement secret shopper service Engage physician leaders to identify & implement best

practices Practice-specific action plans to meet access targets Quarterly deep dive on access data with each PCP

18

Mercy Goals for ProviderMatch Project Consumer-facing view of our CIN

physicians Improve “find-a-doc” searches, to include

better user experience on mobile platform Maximize call center efficiency Reduce misdirected referrals Provider demographic database

19

Access Scoring @ Mercy Developed a model geared for quarterly discussions with

PCPs Considers contract management, productivity, staffing

ratios, staff engagement scores, in addition to these 6 access measures:Measure Target

FTE Adjusted OV Per Day 20

% No-Shows <5%

Slots Per Hour >=3.5

% Slots Restricted <20%

Avg 3rd Next Available <3 days

ACO-1 (CG-CAHPS) 69.7% Top Box

20

Access Scoring @ Mercy

21

If / Then Suggestions for Physician Interviews

Question SuggestionIs the provider providing the min. clinical hours in his/her contract?

If no, review with provider to increase hours to contracted minimum

Is the provider blocking more than 20% of his/her schedule AND under 100% booked?

If yes, remove restrictions on template to allow provider to fill schedule fully

Is the provider blocking more than 20% of his/her schedule AND under the Median?

If yes, remove restrictions on template to allow provider to increase production

Does the provider have at least 3.5 slots/hr avail.?

If not, adjust template to increase physician availability

Is the No-Show rate below 5%? If no, audit practice to ensure no-show policy is being enforced

Is the 3rd Next Avail greater than 3.0 AND slots blocked greater than 20%?

If yes, remove restrictions on template to improve 3rd next available, open slot

Is the provider below the Median AND not accepting new patients?

If yes, need to discuss opening panel up to new patients

22

Mercy Health Physicians Monthly Scorecard (Selected Components)

23

Mercy Health Physicians Monthly Scorecard (Selected Components)

24

Impact of Post-Hospitalization Ambulatory Follow-Up Access Care Coordination initiative to get high-risk ACO patients

into their PCP after hospitalization (Geisinger readmission risk score >=14)

Harder than it should be (access problems) Interesting natural experiment (maybe some selection bias)

on benefits of access:

Seen within 15 days post-discharge

Internal readmission rate

Risk adjusted O/E ratio

Yes 10.8% 0.86No 16.5% 1.22

P value <.01 CareScience Methodology

25

Market Specific Strategies (Lima OH) Adding Advanced Practice Providers to a variety of

settings, including family practice, urgent care, occupational health

Increased focus on Medication Therapy Mgmt Embedded care coordinators in every PCP practice Starting in December, will have 2 Behavioral Health

Consultants covering 4 primary Care offices, available for “curb-side” consults, brief intervention and treatment

Opening new school-based clinic with an Advanced Practice Provider. Access for student body, staff and community

E-Visits and Video Visits Patient portal (MyChart and MyChart Bedside)

26

MyChart Bedside Drives Increased Patient Satisfaction

27

MyChart Bedside Drives Increased Patient Satisfaction

Pilot Survey Results: 98% Strongly Agree they had improved communication

with their nurse 85% Strongly Agree they had improved communication

with their physician 100% Strongly Agree they had a better understanding of

their current medications Dramatic increase in patient satisfaction

scores Nurse Communication: 55% to 75% Responsiveness of Staff: 55% to 75% Medication Communication: 50% to 70%

28

TRICARE Access Standards(What a Concept)

29

J.D. WhitlockVP, Clinical & Business

Intelligencehttp://www.linkedin.com/in/jdwhitlock