There’s a major debate about access to healthcare for all Americans. Indeed, this is at the heart of solving our national healthcare dilemma. Physicians understand that getting medical care to people promptly, when they need it, can prevent catastrophic events and is also an effective way to make care more affordable. The longer we hold off on necessary care, the costlier it becomes.
Patient Experience as a Measure of Access
Access leads to affordability, but it also leads to an improved patient experience. Patients are unhappy with systems that are unresponsive to their needs and that have long waits for appointments. While working as a primary care medical director at Group Health, I realized that the best measures of access were those that measured a patient’s experience. We surveyed members on their encounters and asked if they received care in a timely manner. This is an important lesson for leaders who want to improve access and could have prevented the recent Veteran’s Administration (VA) fiasco.
Don’t Rely on Shoddy Metrics
The VA story began over the last two decades when they, along with most other large systems, implemented Advanced Access in health care. This essentially changed processes to allow same day appointments and greatly reduced waiting for an appointment. The accepted measures for this were the percentage of same day appointments on the books and the percentage of patients who could get an appointment within three days. Leaders felt confident that following these metrics let them know when clinics had adequate access. However, these measures can be skewed by frontline staff to give a false impression of accessibility. Unfortunately, this is exactly what happened at the VA. As we all know, complaints by veterans brought to light the fact that their Advanced Access system was failing them. The simple solution was to improve patient satisfaction metrics and to keep management involved so they’re more connected to the front lines. Allowing patients to rate their experience is a truer downstream measure and a safeguard that leaders can rely on.
How Group Health Improved Access
So now that we know how to identify access issues, how do we solve them? At Group Health, we analyzed the utilization of our members and surveyed their experience to find ways to improve access. We expanded our hours and implemented a team-based approach in our clinics to remove some of the workload from doctors, thereby increasing their availability to patients. We found that when you have a high-functioning team, you have better access.
Additionally, we used workload analysis and complex formulas to predict the number of appointments we could manage for each individual day of the week. We also provided virtual medicine via phone appointments and emails, which allowed us to expedite appointments, removed the issue of transportation and scheduling for many members, and allowed our providers to be more efficient. In fact, we did a spot check of our Primary Care schedules over several months in 2014 and found that 65% of the care given was done virtually. That means that more than half the contacts between physicians and patients occurred via email or phone visits. Our patients also appreciated the fact that they had no copays for those visits. Throughout the process, we continued to validate that we were truly improving access through customer satisfaction surveys and utilization measurements.
The Emergence of Telehealth
The telehealth trend has been catching on in recent years and is currently available in many states. In fact, Blue Shield of California just began offering their members the use of Teladoc in April 2017, featuring 24/7 access to care via telephone, computer, and mobile app. They can even provide prescriptions. Here are some more articles on telehealth, including its expansion into Medicare:
- How Telemedicine is Transforming Health Care
- Momentum Builds to Expand Medicare’s Telehealth Coverage
- Gardner and Peters Introduce Bipartisan Legislation to Expand Telehealth Services
Transportation Assistance
Recent studies have indicated that 25% of patients missed their appointments due to transportation issues. Hospitals and providers have realized the importance of transportation to get their members the care that they need, so many have partnered with services such as Uber and Lyft to arrange rides for their patients and some systems even have their own shuttles.
I hope these tips help other health systems in their quest to improve access for their members. If you’d like help with this endeavor, please contact HCIM President & CEO Michael Wilson at 925-265-4113, ext. 124 or mwilson@hcim.com.
Claire Trescott, M.D.
Practicing Physician & Former Primary Care Medical Director
HCIM Senior Executive Adviser