Exec: Health Systems Succeed Through Effective Ambulatory Strategies

Ambulatory practices can generate value, harness telemedicine, provide access and promote equitable care.

Effective ambulatory strategies are essential to the success of health systems, a senior NewYork-Presbyterian (NYP) says.

With an ever-increasing shift of care from the hospital to the outpatient setting, outpatient care has become an increasingly important sector of the healthcare industry in the United States. Annual revenue from outpatient health care services is about $1 trillion, outpatient practices employ more than 7 million people, and there are more than 600,000 outpatient care facilities, according to statista.com.

Ambulatory care is critical to driving value in healthcare, says Tiffany Smith Sullivan, MPH, senior vice president and chief operating officer of medical services at NYP. “To drive value at the grassroots, you need a patient-centric approach. We need to build teams for patients who manage complex types of care, so that we are aligned, we communicate and we We work with the patient to make sure they have everything they need to stay healthy in an outpatient setting. For example, we want a patient who is managing diabetes not to have to go to the emergency room or “being hospitalized. It’s a condition we can manage in the outpatient setting with community partners to help the patient get what they need to stay healthy.”

Outpatient practices have become leaders in telemedicine, she says. “You have to go back to 2020 when many of our outpatient practices were closed for in-person visits. Prior to 2020, we were dragging our feet on telehealth options for our patients. We were still upgrading our technology. The pandemic has accelerated the pace of building telehealth capacity in the ambulatory space. While we were closed for in-person visits, we were able to identify telehealth platforms, including phone calls and video. It was important to have telephone visits as well as video visits for our patients who live in areas where high speed internet access was not available to them. The pandemic has given us the opportunity to transition to telehealth platforms and be safe in the way we provide patient care.

NYP is committed to outpatient telemedicine, says Smith Sullivan. “We will continue to offer telehealth. About 20% of our patients want this care option.”

Ambulatory care is essential for efficiency and access to care, she says. “Our outpatient strategies to increase efficiency include opening up access to care so patients don’t need to seek care in high-acuity settings such as the emergency department. If we’re not open than Monday to Friday, 8 a.m. to 5 p.m., so we’re leaving out a segment of our patient population. Illness doesn’t just happen Monday to Friday, 8 a.m. to 5 p.m. So we make sure that we have extended hours and weekend hours to ensure that we can provide access to our patients whenever they need care We want them to be able to get care in an outpatient practice, rather than to seek emergency treatment.

NYP tries to schedule outpatient visits within at least seven days, Smith Sullivan says. “We are identifying opportunities to expand primary and specialty care in areas where we are seeing backlogs. This means if you call today, how long does it take us to get you an appointment? We have measures for that, and we want to make sure that if we see a community that has high latency, we look at those trends to determine where we need to place primary and specialist care resources.”

The health system is expanding its ambulatory care network to improve access, she says. “We make sure we understand where we have significant lags using trend data. This may mean an increase in staff, such as more advanced practice providers, including nurse practitioners and physician assistants in our practices. We are not only looking at the structure of the type of caregivers we have in our practices to meet the needs we see in our communities, but also looking at where the needs are growing and changing with respect to primary care and different types of care specialized. »

Using ambulatory care to promote equity

Equity is one of the goals of the NYP’s ambulatory care strategy, says Smith Sullivan. “Each community in New York City has its own flavor and its own underlying resources. So we need to make sure that we have strong partnerships in our communities and strong relationships with our patient population. We need to streamline what “It takes to walk in and see a provider like having a centralized contact center, which is a process in place at NYP starting with primary care. It improves access for all of our patients.”

NYP’s outpatient practices are closely tied to the community, which supports equity in care, she says. “Our greatest opportunity with our socio-economically disadvantaged populations is to understand the community, to understand community pain points and to work with community organizations. For example, we have strong partnerships with faith-based organizations, health services school-based health centers and programs that help people get healthy food, so integration with these programs and organizations is part of building trust in the community and ensuring that care is equitable in terms of access and opportunity to see a provider of your choice. We need to be embedded in our communities, be linked to community organizations and have meaningful partnerships.”

Develop ambulatory care

Opening new outpatient practices remains a cornerstone of expanding outpatient care at NYP, Smith Sullivan said. “Brick and mortar is still our biggest game in terms of the volume of patients we see, so we spend a lot of time and energy figuring out where we have bottlenecks and where we have health issues. access in terms of patients not being able to get an appointment in seven to 14 days, which may mean we need additional physical location.We also want to look at how we can open our hours to accommodate these patients.

Data drives decisions about opening new outpatient practices, she says. “There are several metrics that help us decide if we should expand, where we expand, and what kind of services we expand in a community. feedback from our engagement surveys, such as how long patients stay on the phone. We review our quality measures to ensure that our patients receive high quality care. If we find that our doctors are overloaded, we often see a correlation with some of our quality indicators.”

Christopher Cheney is the Clinical Care Editor at HealthLeaders.

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