Access Part 1 and 2 - chad.memberclicks.net · Access Part 1 and 2 Prepared For: CHAD Prepared By: Shannon Nielson, MHA, PCMH-CCE Principal Owner/Consultant ... •Standardization

*All documents are property of Curis Consulting. Do not duplicate or distribute without written permission.

Access Part 1 and 2

Prepared For: CHAD

Prepared By: Shannon Nielson, MHA, PCMH-CCE

Principal Owner/Consultant

*All documents are property of CURIS Consulting. Do not duplicate or distribute

without written permission.

Assessment: Access

• Access is defined as an attempt (successful or unsuccessful) by a patient to have an intervention with their provider or care team. In a value based environment access is measured by appropriateness, availability, accessibility, accommodation and affordability. Health centers will need have information and awareness within each of these measures both within their four walls but within the healthcare community to deliver on the promise of the quadruple aim. Health centers were assessed on the following:• Adoption of value based access measures• Utilization of access data to drive other population health strategies• Access beyond productivity and no shows• Access to and utilization of access data for community partners• Access as a measure of cost



Access

• Access: A member’s contact with their PCP• Direct correlation (increased access=increased cost)

• How many times are your patients utilizing your services?

• Are your members utilizing your services appropriately?

• Do you provide access appropriate to your population?

• How can a patient access us without a visit?---IT?

• Do our staffing ratios enable patients to have appropriate and less

costly care?

• Overall care vs. Primary care cost of care



Access Evolution

FFS• What is our bottom line?

• Patient Count

• Capacity

Quality/Value• Who are our patients?

• What do our patients need/want?

• How much capacity can we provide?

• What is cost effective access?

• Who and what provides access?



Access Key Drivers

• Scheduling

• Staffing

• IT

• Patient Needs

• PATIENT DEMANDS



Access – More than Scheduling Appointments!

• Five Dimensions of Access:

1. Availability

2. Accessibility

3. Accommodation

4. Affordability

5. Acceptability

• How can we assess and address each dimension and to improve and enhance overall Access?

Access

Availability

Accessibility

AccommodationAffordability

Acceptability



Availability

• Availability: The relationship between volume/supply and demand



Accessibility

• Accessibility: The relationship between location of supply and the location of the patient



Accommodation

• Accommodation: The relationship between organization of services and patient needs



Affordability

• Affordability: The relationship between prices and the patient’s ability to pay



Acceptability

• Acceptability: The relationship between the patient’s personal preferences/expectations and the provider’s actual delivery



Foundational Access Measures

• Patient Retention• Track unique patient numbers and compare to month of previous year• Set target based on 330 Grant

• Patient Retention 2• Patients seen in 2014 and again in 2015 and 2016• Patients seen in 2014, 2015 and not in 2016• Patients seen in 2014, not in 2015 and seen in 2016

• No Shows- Not necessarily Access• Productivity- How did you set your goals?



Meaningful Access Data Collection

• 3rd Next Available

• Continuity

• Schedule Utilization

• Panel Size

• Team Access

• Appropriate Access

• Patient Engagement

• Coordination



Access Interventions• Do you provide access appropriate to your population?

• Do you have the appropriate and right quantity of appt. types in your schedule?

• Are your provider’s over capacity?

• How do you utilize your providers?

• Do you offer the appropriate hours?

• Do you rob Peter to pay Paul?• By provider

• By appt. type

• Best Practices:• The CURIS 3rd NA semi-annual study

• Seasonality of schedules

• “Shift hours” (staggered provider hours to provide convenient access)

• Acute care provider



Access Interventions

• How many times are patients accessing your services? Are your members accessing your servicesappropriately?• Questions Answered:

• Walk/In & Same day abuse

• Inappropriate follow up schedules

• Best Practices:• Walk In Utilization policy

• Standardization of guidelines for follow up (i.e. lab result review, controlled vs. uncontrolled diabetic)



3rd Next Available



Continuity of Care

30%

20%

10%

0%

40%

50%

100%

90%

80%

70%

60%

Axi

sTi

tle

Continuity of Care

Goal

PCP Continuity



Continuity of Care: Where is the Access issue?



But is that really the issue?...



Panel Size



Empanelment Process

• Complete RSP Worksheet

• Run list of current provider panels

• Re-distribute following below criteria:• PCP is no longer present

• Plurality of visits

• Acute vs. Established visit

**Always check patient preference when re-distributing



Case Study3NA Continuity of Care Empanelment Identification

Dr.X Acute: 0 days ED F/U: 7 daysWell Adult: 5 days Well Woman: 14 days New Patient: 2 days

75% of patients with Dr.X as PCP are seen by Dr.X

65% of Dr.X visits are patients with otherPCPs

RSP: 1792Current: 1425

1. Acute care provider?2. New Provider?3. Is he seeing more of Dr.Y or

Dr.Z patients? Are they over-empaneled?

4. Do we need more ED and Well Woman appts?

Dr.Y Acute: 2 daysED/FU: 10 days Well Adult: 2 daysWell Woman: 30 days New Patient: 36 days

88% of patients with Dr.Y as PCP are seen by Dr.Y

96% of Dr.Y Visits are patients with Dr.Y as PCP


1. Older population?2. High ED Utilization?3. Does population need well

woman exams?4. Nearing max capacity5. High patient satisfaction?6. Chronic vs. routine pop?

Dr.Z Acute: 1 dayED/FU: 3 days Well Adult: 4 days Well Woman: NANew Patient: 4 days

90% of patients with Dr.Z as PCP are seen by Dr.Z

98% of Dr.Z visits are patients with Dr.Z as PCP


1. Appointment lengths toolong?

2. Productivity low3. Open access?4. Build panel with Dr. Y or

Dr.X?

Other Questions to Ask? Are we stealing appt. types to make room for others?

Is there a preference for provider outside of PCP?

Why the variance in appt. length?

Is there a patient satisfaction issue?




• Can a person access us without a visit?• Do we speak to patients after hours?• Do we call patients during hours?• Do patients call and walk in?• Do we utilize the portal?• Utilization of care coordinator/care manager

• Best Practices:• Patient assessment• Marketing and Patient Materials• Patient/Board Portal Enrollment training• RACI-Care Coordinator Role



After Hours Survey

• Have you tried calling our office after hours to speak to a nurse or provider?

• What did you call about?

• If no, did you know you could call after hours to speak to a provider for an urgent care need?



ED Survey

• Have you been to the ED since your last visit?

• Why did you go the ED?

• Did you try calling our office first?

• What time of the day did you go?



Alternative Access Utilization

• Would you?

• When would you?

• Why would you?

• Why not?




• Do we have the appropriate staffing to provide appropriate access

• What is your phone and portal triage process?

• Do you triage all walk ins?

• What time does your call center open?

• Best Practices

• Dedicated Triage Nurse

• After Hours Triage Nurse

• Triage nurse hours = call center hours

• Clinically staffed call center

• Non provider visits

• Triage vs. Same day appointments



RACI Tool



Criteria Core Credits

AC01: Identify access needs and preferences of patient population X

AC02: Same day appointments X

AC03: Routine and urgent appointments outside regular business hours X

AC04: Provides timely clinical advice X

AC05: Documents clinical advice X

AC09: Uses information about population to assess equity of access +1

AC10: Selects PCP X

AC11: Sets goals and monitors % of visits with selected PCP X

AC13: Reviews and actively manages panel sizes +1

TOTAL 7/7 +2

AC14: Your Transformation Application

You have it, but not transformative Credits

AC07: Has a secure electronic system for patient to request appts, refills, test results +1

AC12: Provides continuity of medical record information for care and advice when closed +1



Access beyond your 4 walls…



Access – Beyond your 4 Walls…

• Five Dimensions of Access Beyond Your Walls:

1. Availability

2. Accessibility

3. Accommodation

4. Affordability

5. Acceptability



Access-Care Coordination

• More than closing the referral loop• Care Coordinators

• TOC Managers

• PCMH- performance of your specialists

• Exchange of Information• MOU/MOA

• Medical Neighborhood Development



Access-Patient Experience or Engagement?• I was able to get an appointment in a timely manner?

• My definition of getting an appointment in a timely manner is:

• Answer vs. Reason



External Access Data

• Timely completion of referrals/orders

• Referral/order Outcomes

• ED Utilization

• Hospital Readmission

• Community Resource Follow Up



QUESTIONS/COMMENTS??