Taking Responsibility for How Patients Access Care
By Jordan Epstein
It’s a familiar scene that plays out time and time again across the country. Mr. Anderson, a middle-aged, slightly overweight department store manager, goes to a doctor in internal medicine at a local clinic complaining of generalized pain in his stomach. He is quickly ordered a CT scan for URQ abdominal pain, which is not so quickly denied by his insurer’s utilization management. Mr. Anderson is left in limbo for weeks, and ends up in the ER of an academic hospital with an infection of the gallbladder and receives an emergency open cholecystectomy. He recovers slowly, and months later he receives a series of bills totaling nearly ten times the expense of the laparoscopic surgery he would have received had he been recommended for appropriate testing.
The IM doctor who ordered his original test never follows up with Mr. Anderson to realize that he never was able to follow the care path.
We’ve all seen this time and time again, and there is nothing new about this situation. What is novel is that there are new technologies which, combined with forward-thinking provider leadership and processes, can enact change and drive outcome improvement and sustained revenue growth in both volume and value-based markets. As competition continues to grow and systems compete for market share, incremental volume and smarter direction of patients becomes king.
Let’s play this again–Mr. Anderson sees his IM doctor, the doctor uses clinical decision support to determine medically necessary care and streamline utilization management, an intelligent referral management solution to confirm coverage, schedule and best value location, and the patient leaves confident with knowing where and when to receive his next care. When Mr. Anderson forgets where and when his appointment is, he gets an electronic reminder on his phone with a calendar invite, and gets the appropriate ultrasound showing gallstones, timely follow-up and laparoscopic surgery, and recovers in days.
There are many places across the country that are making a difference. At the first Patient Centered Medical Home in the Bay Area, MyHealth Medical Group uses technology that proactively understands each patient’s care path, engages in shared decision-making to confirm choice and place of care pathway, and tracks costs and utilization to drive better outcomes and revenue.
At larger health systems, executives across the C-suite are prioritizing putting personalized, relevant patient access tools across the care continuum, including point of care referral tools, tailored patient portals, and advanced coordinator command centers. As younger demographics seek on-demand services and more than half of employer-sponsored plans move to HDHP and narrow network plans, providers that proactively engage and personalize care for consumers are reaping higher retention, occupancy, and revenue. And that doesn’t even begin to cover the efficiencies gained from fewer support staff, phone calls, peer to peers, faxes, confusion from care coordination and savings from better value delivery of care.
The results can be stark: 30% reduction in ancillary spend, 15% reduction in overutilization, 10% increase in compliance, 13% increase in revenue. And that’s without measuring the value of improved provider and patient satisfaction. Adopting new technology and workflow change is tough, but the best healthcare leaders are already taking action to make change.
About the author:
Jordan Epstein is the CEO and founder of Stroll Health. He has served as an expert witness to the US House of Representatives on digital health technology, and represented the United States as the keynote speaker at the World Health Congress in China. Prior to Stroll, Mr. Epstein led product for NICE’s SMB Performance Management line. He also designed and implemented multi-million dollar cloud business intelligence projects across verticals, and his clients have included United Healthcare, Kaiser, Chase, and Delta.
About Stroll Health:
Large integrated systems and advanced independent practices trust Stroll to provide a tailored patient experience that improves compliance and access to quality care. With an intelligent value-based referral system and advanced consumer access solution, including insurance verification, automated prior authorizations, real-time scheduling, out-of-pocket cost estimates, and effective patient reminders, Stroll saves time for providers and patients and drives meaningful, measurable improvement in both volume and value-based revenue. Stroll Health is based in San Francisco, California.
About MyHealth Medical Group:
My Health Medical Group is the first certified Patient Centered Medical Home in San Francisco with improved care delivery through better-coordinated care, reduced costs, and improved outcomes. Patients can receive access to same day care, secure electronic communications with their physician, and connect with an efficient, experienced healthcare team. MyHealth Medical was established in 2012 as an affiliate of Brown & Toland Physicians, in San Francisco, California.