Health systems are seeking to create an environment where they can provide patient-focused, well-coordinated, and high quality care across their entire network, delivering greater value to patients and creating significant returns to the organization in the process. A challenging factor to creating this “systemness” is that there were over 100 M&A transactions in healthcare in 2017 – and a record number of mega-deals – and it’s difficult for these entities to have systemness when they’re constantly changing.
Health systems can only achieve a state of systemness by understanding the components of their networks and how patients can access them. This requires them to have a centralized understanding of the makeup of their provider networks and insight into demand-supply dynamics across access points. Thus, analytics have a powerful role to play in the quest for systemness. Capturing and analyzing the critical data elements in the areas below will go an especially long way in enabling healthcare organizations to achieve systemness.
Provider Network Composition
Creating a curated, unified and clinically accurate provider directory is the foundation of systemness. The data for this directory exists in pieces in health systems’ EHR and credentialing systems, but it must be consolidated, normalized and then further enriched by engaging clinical leadership and providers. Without clinical engagement it will be nearly impossible to capture providers’ clinical areas of focus clearly or to adjudicate overlapping areas of focus (e.g. who should be performing spine surgeries – orthopedics or neurology). Once in place, leadership will be on the path to systemness with a complete understanding of how many providers are in their network, what their clinical areas of expertise are, and where they are located.
Understanding appointment wait times is also key to driving systemness, not only to optimize clinical outcomes, but also to improve the overall patient experience. A common metric for this is “third next available” appointment, which is the average number of days between the day a patient seeks an appointment and the third available appointment for a new patient physical, routine exam, or return visit exam. This is a more sensitive measure of true availability than next available appointment since next available can reflect cancellations or other unforeseen events. Understanding how long patients are waiting for appointments and how this varies across geographies and specialties can help leaders determine how their systems are performing overall on this key aspect of patient experience, as well as identify specific areas where they may need to take action to improve wait times.
At the heart of systemness is making sure that when patients require more specialized care or consultation, it occurs within a health system’s network, assuming they have the appropriate expertise and availability in-network as highlighted above. This enables the health system to facilitate care coordination and drive clinical outcomes by ensuring patients receive the follow-up care they need with an appropriate provider. Monitoring and understanding where and if referral appointments are being booked is paramount. Some organizations seek to enhance the patient experience at the same time and bring systemness to the next level by rolling out processes to ensure the patient has a referral appointment booked prior to leaving their current visit.
Supply / Demand
Once the health system has visibility into the above areas (supply), they must turn their attention to analyzing patients (demand). This data is made up of inbound online activity, such as appointment bookings through the website, as well as requests through the organization’s call and referral centers. The analytics behind this must be granular enough so the data is actionable and will allow health leaders to take informed steps to align demand with supply (e.g., recruiting more providers or expanding/relocating care sites), preventing patient access challenges that hinder their ability to act as a system and retain patients within it.
While each of the above metrics is powerful and actionable in its own right, health systems stand to gain the most by looking at them in conjunction with each other and viewing them as contributors to what is the most telling metric for systemness – schedule density. Schedule density is the byproduct of a comprehensive provider directory that includes availability, clinical configuration, and locations mapped against patient demand. If a health system has this and can react to changes in their market by influencing the levers associated with it, they will be far along on the systemness spectrum.
Scott Andrews is the Senior Vice President of Delivery at Kyruus, where he is responsible for implementations, customer success, and ongoing support of the Kyruus client base. Prior to joining Kyruus, Scott worked at athenahealth, Inc. for 17 years where he served in leadership roles in Client Services, Operations and Finance.