Ambulatory Enterprises: The Patient-Centric Redesign

Quarterly CheckUp

Health Solutions

February 1, 2015

Perhaps the most consistent trend in healthcare is the steady rate at which outpatient spending growth has outpaced inpatient spending since CMS introduced prospective payments in the 1980s, more than three decades ago. The outpatient spending growth rate has increased by nearly double that of inpatient among privately insured populations in the past five years alone. This trend shows no sign of slowing as the healthcare industry transforms to a value-based model of care and reimbursement. For health systems, this means outpatient services will represent both an increasingly important component of the Operating Statement and an increasingly important strategic venue in the world of population health management, satisfaction-based reimbursement and increased healthcare consumerism. The bottom line: providers must transform their ambulatory enterprise in a manner that aligns organizational structure, financial performance and the patient experience.

FTI recently assisted a renowned health system to jump-start its patient-centric ambulatory services redesign. Of particular challenge was an existing enterprise model reflective of varied historical approaches to multispecialty development and geographic strategies layered over the years. However, the organization rallied around the challenge in the face of three major catalysts – macro reimbursement changes, heightened local market competition and the organization’s upcoming major clinical system installation. FTI worked closely with multiple levels of the organization to create momentum around moving from its historic ambulatory delivery system and processes to a transformed future model through:

  • Employing a proven, systematic approach to aligning people, processes and technology, focusing on revenue cycle and related activities;
  • Evaluating patient experience, satisfaction and supporting measurement tools and metrics;
  • Illustrating the existing funds flow and identifying inconsistencies, inefficiencies and non sequiturs; and
  • Recommending specific operational changes for improvement.

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