Health and Wellness

Liberate the Data to Improve Patient Access

by Peter Dunphy, Partner, CWH Advisors and Kelly Utton, Partner, CWH Advisors

Patient access has been a hot topic for decades – long before digital front doors, Fast Healthcare Interoperability Resource (FHIR) standards, interoperability, and post-pandemic provider burnout.  Whether we want to or not, we all eventually become consumers of healthcare.  Unfortunately, when that happens, people can’t find and access the care they need and want.  Everyone can relate to the frustratingly long wait period to be seen by a provider, but does the data validate their frustration? Yes, as the average patient appointment wait time is up 8% since 2017 and 24% since 2004, with recent data showing it took roughly 26 days for a new patient to get a provider appointment in 20221. 

Access problems result from many interrelated issues like affordability, lack of transportation and lack of available appointments or the expected shortage of medical providers. We’ll explore capacity vs. access and the sophisticated role the data plays.

Access isn’t just about Capacity

The current challenge of patients struggling to get medical appointments isn't simply a matter of overwhelmed healthcare systems. While capacity limitations are real, they often mask a more nuanced problem: a lack of access to the right level of care. Patients might be funneled into appointments with specialists when a primary care physician could address their needs efficiently. This mismatch between the type of care needed and the care available creates bottlenecks, leading to long wait times and frustrating scheduling experiences.

The massive amount of information and data to support patient access analysis exists across the healthcare ecosystem. Data exists about the providers, the appointment schedules, the patient and the patient’s condition, the covered benefits, the available primary care providers and specialist network. Critical information exists in governed silo’s, all related to the goal of a facilitated digital consumer navigation experience.

Conventional wisdom tells us there is a shortage of providers. Though it is true in most cases, providers are burning out, and leaving the system, while care delivery staff are hard to find. The Association of American Medical Colleges projects that by 2034 there will be a shortage between 17,800 and 48,000 primary care physicians and between 21,000 and 77,100 non-primary care physicians2.   However, there are also systemic problems that lead to inefficient use of the available capacity.  The real challenge is connecting a specific patient to the right resource when they need it and often the obstacle is not having the information and data in hand or not being able to act on it.

It's about the data

Making the connection for a patient to the right care resources at the right time requires information and data management across a variety of complex sources.  Data across multiple types of care settings, including virtual, is key as it relates to the patient’s:

  • condition(s) (electronic medical record and claims),
  • benefits coverage (health plan),
  • network of providers (network management),
  • resources with availability (appointment schedules).

Allowing data to be “freed” to exchange outside traditional organizational walls and well-governed in a central place will support better use of available capacity in the healthcare system and improve patient access.  Examples of care outside traditional office settings with potential capacity to see patients include virtual care appointments, convenient/retail care locations, and home care alternatives.

Liberating and connecting existing data across the healthcare ecosystem will improve access to available capacity and resources that are otherwise unknown:

  • Timely, virtual visits and models that help promote the next best action and the matching of the patient to the right place and right resource (for the right quality and cost).
  • Physician assistants and nurse practitioners with timely available appointments will help ease the burden on booked provider schedules while also encouraging top of license practicing.
  • Appointment slots available/freed to consumers help simplify the administrative scheduling burden. The current state of healthcare access and scheduling has essentially forced consumers to become triage experts for their own care, navigating a complex system with limited transparency.

Is access simply an appointment – no it’s the right appointment within the right time with the right provider for the right cost/quality outcome.  Getting that correct and to the expectation of the patient while encouraging providers practice at top of license takes creative care models and excellent data sharing.

Examples of Liberating the Data

In our work we see examples of solutions emerging.  There are some key themes that have emerged about the elements of solutions addressing this need – all of which call for liberation of data to address consumer needs:

  • Consumer (patient or caregiver) as owner of their longitudinal medical record outside the traditional walls of a health system – with customized next best actions that promote right care and right level of provider see example here.
  • Payer/provider collaboration efforts that support better care navigation and member experience – Omni channel experience and journey that results in a satisfied consumer, enabled by technology, and sourced by data liberated from both provider and payer. Providing personalized care services delivered to patients through a range of channels, such as online platforms, mobile applications, and telehealth, can result in augmenting patient engagement and satisfaction. Patients can receive treatment from a primary care provided by a physician, specialist, or pharmacist without the necessity of physical appointments, thus reducing wait times and improving overall patient outcomes and satisfaction3.
  • Optimize the available appointment supply and demand across a network and close the appointment loop - facilitate the appointment process – through interoperability and high quality, accurate data exchange between and across traditionally siloed stakeholders see example here.

Appointment scheduling access and automation make it easier for all involved stakeholders.

  • By connecting different healthcare systems (interoperability) and using accurate, up-to-date information (high quality data exchange), it is possible to:
    • Match patients with available appointments faster: No more wasted time searching directories and looking for openings.
    • Close the appointment loop: This means making sure everything is confirmed and everyone involved is on the same page.
    • Help everyone involved: This includes patients, doctors, insurance companies, and caregivers. Everyone benefits from a smoother process.

Establishing the right place, right provider level, right severity appointment type, right time, right cost/quality - requires complex data insights used to better manage capacity therefore improve access to care. There is no doubt across the industry that there is a need to ease the burden on traditional primary care office schedules and improve access to care for patients and caregivers4.

Liberating the data and defining collaborative processes around how this centralized information supports consumers in care navigation processes will better connect patients to the care they need. In order to meet the consumer where they are - liberate the data (and also some appointment slots across the supply chain) so those technology organizations doing good work for patients and providers can help solve this massive access problem. 

There is capacity. Maybe not always, but there is more than you think.

References

 

Tags: Health and Wellness, Patient Access, Care
Published on May 24, 2024

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