The possibilities for ambulatory care expansion are almost endless. So are the risks.
Expansion of ambulatory and outpatient care networks makes sense for several reasons, including the desire to improve patient access, strengthen patient-provider relationships, and increase revenue.
Growing pains, however, are common in the quest to become virtually omnipresent in the daily lives of consumers and potential consumers. Consider the following:
1. Make a Mindset Shift
"Historically, we have viewed ambulatory and postacute care as means to support hospitals," says Scott Nordlund, executive vice president for growth, strategy, and innovation at Trinity Health, a Livonia, Michigan–based not-for-profit with facilities in 21 states and annual operating revenue of about $15.9 billion.
Getting the Value Out of Postacute Care
"As we wade into the world of population health and begin to think about networks of care—including outpatient ambulatory networks—in many cases, we're investing as much there as we are in our inpatient facilities. Not everything is necessarily centered around the hospital," he says.
2. Understand Various Settings
Seemingly natural means toward outpatient population health include partnering with, acquiring, or establishing physician organizations. But doing so isn't necessarily simple.
"The expertise that it takes to run and have well-managed acute operations—those skills don't necessarily translate to what it takes to run a network of care," Nordlund says. It requires "learning new skills in terms of how to put together real-estate deals, how to acquire physician practices in a meaningful way, and how to aggregate those practices into well-performing networks."
Reducing Readmissions From the Postacute Setting
For health systems, the trick is to assess outpatient opportunities in a strategic, proactive manner, rather than a reactive one, says James F. Kravec, MD, FACP, executive vice president and chief clinical officer for Mercy Health Youngstown.
It is an integrated health system employing more than 6,000 and serving four counties in Northeast Ohio. MHY is one of eight regions of Mercy Health, a 23-hospital health system serving Ohio and Kentucky, with assets of $6.1 billion and net operating revenue of $4.5 billion.
"We have found that locally and nationally, many groups are acquired when there was no other option or when there was a need on behalf of the practice," he says.
"I think we've found that the best way to acquire a medical group is to focus on when there's a hospital strategic need and making sure you continue on the mission and strategy of the hospital by focusing on what you're focusing on. Don't change it to fit one practice, because that's where you make mistakes."
3. Rethink Partnerships
In addition to acquisitions, strategic partnerships can also help health systems expand into the outpatient space; but not all such relationships are created equal, says Nordlund.
"In these spaces, partnerships make a lot of sense," he says. However, when it comes to aligning oneself with others' expertise, and in turn giving up some measure of control, healthcare leaders should consider carefully who their partners are, how they reflect on their organizations, and the plan of action if there is a problem, Nordlund says.
"These are not vendor relationships. These are true partnerships, so it's really important to think through what that means to you well beyond just return on investment," he says.
4. Assess Demand
"We view that the future of healthcare is going to be more and more about outpatient services, so we've intentionally been trying to add new outpatient centers and make sure we have a strong outpatient network throughout the region that we serve," says Paul Tait.
He is chief strategic planning officer for Cleveland-based University Hospitals Health System, an integrated network of 18 hospitals with more than 40 outpatient health centers and primary care physician offices in 15 counties throughout Northeast Ohio.
Nonetheless, leaders must be careful to assess demand before placing physicians anywhere, particularly for specialists, adds Richard Hanson, president of University Hospitals' community hospitals and ambulatory network.
Some outpatient centers, as a result, include timeshare suites in which each specialty physician might work two days per week, and work out of other centers the remaining days. "That way you're offering services locally but you're also keeping the physician productive in terms of how time is used," he says.
University Hospitals physicians are also grouped strategically to allow them to cross-cover for one another and share evening and weekend call coverage.
5. Exceed Expectations
In carrying out its outpatient vision, Main Line Health, a 1,387-bed health system with $1.4 billion in annual operating revenue based in Bryn Mawr, Pennsylvania, has opened four major health centers in the greater Philadelphia region. And in winter 2016, MLH added an ambitious fifth center in Concordville.
Post-Acute Care Has a Quality Management Problem
The new center fills three stories and 135,000 square feet. The expansive space not only includes physician offices and high-tech ancillary services but also a medically supervised fitness center and pool, an urgent care center, and café where only heart-healthy food is served.
Despite these efforts, long-term patient loyalty is not guaranteed, says Lydia Hammer, MPH, MLH's senior vice president of marketing and business development.
"It's a pretty heavily resourced market. There are a lot of doctors. There are a lot of outpatient centers. You can get an x-ray pretty much on any corner. So we have to provide a better product, and that means we have to be easier to do business with and demonstrate the high quality of our services," she says. "We have to always provide outstanding quality and have people feel like we exceeded their expectations."
A few of many musts for making a top-notch impression, according to leaders, include sharing a common electronic medical record throughout one's network and with partners; deploying time-saving technology such as self-scheduling tools, e-visits, etc.; and putting primary care at the center of offerings to facilitate population health and establish patient-provider relationships.
Debra Shute is the Senior Physicians Editor for HealthLeaders Media.