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Patient Access in the World of Value-Based Care

Published on 4/2/2018

Patient access plays an important role for organizations transitioning from volume- to value-based care. It’s often the first point of contact in an episode of care, an opportunity to make a positive and lasting impression on a patient’s experience. 

Many organizations will need to evolve their patient access strategies to adapt to this change. Starting with the front-end, the coordination of timely, standards-based and consumer-centric care can increase patient engagement, loyalty, and yield better outcomes.

In celebration of Patient Access Week (April 1-7, 2018), here are some considerations for preparing your own patient access strategy for the world of value-based care.

Providing timely, coordinated, standards-based care

Many organizations are well prepared to triage emergent care situations through same-day appointments, urgent care appointments and emergency departments. But when a situation is not evidently emergent, the care process can often be fragmented and result in unnecessary delays.

Traditional fee-for-service care models are designed to maximize the productivity of providers and resources. The responsibility of seeking and scheduling care falls on the patient, and each subsequent activity in his/her treatment is often dependent on or delayed until a previous action takes place. 

In a value-based care model, health care organizations share this accountability to identify and coordinate all necessary activities for an episode or entire treatment plan to increase the likelihood of the best health outcome. Care coordination should include (but is not limited to) the following steps:

  • Quickly triage a patient’s symptoms and conditions
  • Determine the risk of a situation becoming emergent
  • Apply appropriate care standards
  • Follow care standards and activities in a timely manner 

An organization’s patient access department is increasingly responsible for the coordination of care. The typical demands of the scheduler will likely shift from coordinating a single visit or multiple visits across a single service line, to facilitating multiple visits across an episode of care. 

Scheduling is already a complex process that encompasses multiple factors, including patient preferences, provider preferences, care standards, insurance requirements and more. The shift to value-based care will require sophisticated technology with embedded intelligence to further automate the scheduling process, while considering the patient’s clinical record and preferences, provider preferences, and the organization’s care standards. 

An important facet of timely care is determining the right ‘target’ levels of access to providers, based on resourcing and patient volume thresholds. Provider schedules should be regularly reviewed and optimized to meet or exceed these targets to ultimately provide more timely care. 

Before making any potential changes to provider schedules, seek input from leadership and/or the providers themselves. If you haven’t already, establish a governance structure and organizational change management program to engage your stakeholders in these decisions. Provider buy-in and a solid governance approach can make all the difference: changing a schedule to accommodate blocks for potentially emergent situations may result in better access, satisfaction and outcomes — but if improperly managed, it could also result in provider and patient dissatisfaction. 

Consumerism and patient engagement

Care coordination alone is not enough. Patients must be able to trust an accountable care organization (ACO) or risk-based provider with their care. Success in value-based care requires a shared commitment and accountability.

With the rise of consumerism, patients are increasingly becoming more demanding "shoppers" — looking for the easiest access to care, and transparency into the quality and cost of that care. This shopping mentality could be detrimental to providers in a value-based reimbursement model. Direct-to-consumer applications and marketing may increase the likelihood that patients seek out-of-network care, which could result in revenue leakage. The best method to protect your market share is to build loyalty among your patients. 

Patient access has a critical role at the forefront of the care experience. Patient access personnel can make a positive first impression by providing excellent customer service and setting clear expectations throughout all pre-service interactions including scheduling, financial clearance, and check-in/admission.

A proactive financial clearance process can help patients understand their insurance coverage and out-of-pocket costs, and when necessary, arrange a payment plan. Patient access personnel can serve as patient advocates simply by showing compassion and offering education on payment and financial assistance options, which in turn builds their trust and loyalty with the organization.

Self-service options, provided through mobile and kiosks, present another opportunity to build engagement and satisfaction. They can also further streamline the scheduling, pre-registration, and check-in processes. Patient access personnel can support increased adoption by educating patients on these self-service options and how to use them.  

The lasting impact of a good first impression at patient access can set a positive momentum for the entire episode and help build patient loyalty. According to a Conance Consumer Impact Study, 95 percent of patients who are fully satisfied with billing would return to the same hospital for a future elective service. Patient access continues to be so important to creating a clear and positive experience, even more so as traditional processes evolve. Organizations that address these considerations early-on in their own strategies are better positioned for value-based care, but also to optimize access and create positive, lasting relationships with patients.

Join Cerner in celebrating Patient Access Week 2018! Share this blog on social media, use hashtag #AccessWeek18 and tag Cerner in the post. Click here to learn more about Cerner’s integrated patient access management solutions and transaction services.