The Exec: Health Systems Succeed With Effective Outpatient Strategies

Outpatient practices can drive value, harness telemedicine, provide access, and promote equitable care.

Effective outpatient strategies are critical to the success of health systems, a top executive at NewYork-Presbyterian (NYP) says.

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

Outpatient care is essential to drive value in healthcare, says Tiffany Smith Sullivan, MPH, senior vice president and chief operating officer of physician services at NYP. "To drive value at its core, you need a patient-centered approach. We need to build teams for patients that manage complex types of care, so that we are aligned, we are communicating, and we are working with the patient to make sure that they have everything they need to remain healthy in the ambulatory setting. For example, we want a patient who is managing diabetes to not have to go to the emergency department or have an inpatient stay. That is a condition that we can manage in the ambulatory setting with community partners to help the patient get what they need to stay healthy."

Ambulatory practices have become leaders in telemedicine, she says. "You need to go back to 2020, when many of our outpatient practices were closed for in-person visits. Before 2020, we had been dragging our feet on telehealth options for our patients. We were still getting our technology up to speed. The pandemic accelerated the pace of building telehealth capabilities in the ambulatory space. While we were shut down for in-person visits, we were able to identify platforms for telehealth including phone calls and video. It was important to have telephonic visits as well as video visits for our patients who live in areas where access to high-speed Internet was not available for them. The pandemic gave us an opportunity to shift to telehealth platforms and be safe in how we provided care for patients."

NYP is committed to telemedicine in the outpatient setting, Smith Sullivan says. "We are going to continue to offer telehealth—we have about 20% of our patients wanting that option for care."

Outpatient care is essential for efficiency and access to care, she says. "Our outpatient strategies to increase efficiency include opening up access to care so that patients do not need to seek care in high-acuity settings such as the emergency department. If we are only open Monday through Friday, 8 a.m. to 5 p.m., then we are leaving out a segment of our patient population. Sickness does not only happen Monday through Friday, 8 a.m. to 5 p.m. So, we are making sure that we have extended hours and weekend hours to make sure we can provide access to our patients whenever they need care. We want them to be able to seek care in an outpatient practice, rather than seeking care in the emergency room."

NYP is trying to schedule outpatient visits within at least seven days, Smith Sullivan says. "We are identifying opportunities for expansion of primary and specialty care in areas where we see lag times. That means if you call today, how long does it take us to get you into an appointment? We have metrics for that, and we want to make sure that if we see a community that has a high lag time, we look at those trends to address where we need to place primary and specialty care resources."

The health system is expanding its ambulatory care network to improve access, she says. "We are making sure that we understand where we have significant lag times by using trend data. It can mean increased staffing such as more advanced practice providers including nurse practitioners and physician assistants in our practices. We are looking at not only the structure of the type of caregivers we have in our practices to address the needs we see in our communities but also looking at where the need is growing and shifting related to primary care and different types of specialty care."

Using ambulatory care to promote equity

Equity is one of the goals of NYP's outpatient care strategy, Smith Sullivan says. "Each community in New York City has its own different flavor and has its own underpinning 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 get in and see a provider such as having a centralized contact center, which is a process in place at NYP starting with primary care. That improves access for all of our patients."

NYP's ambulatory practices are closely linked to the community, which supports equity in care, she says. "Our strongest opportunity with our socioeconomically disadvantaged populations is to understand the community, to understand the pain points in the community, and to work with community-based organizations. For example, we have strong partnerships with faith-based organizations, school-based health centers, and programs that help people obtain healthy food. So, integrating with those programs and organizations is part of building trust in the community and making sure that care is equitable in terms of access and being able to see a provider of your choice. We need to be embedded in our communities, to be tied in with community-based organizations, and to have partnerships that are meaningful."

Expanding ambulatory care

Opening new outpatient practices remains a cornerstone of expanding ambulatory care at NYP, Smith Sullivan says. "Brick and mortar is still our biggest play in terms of the volume of patients that we see. So, we spend a lot of time and energy on where we are having bottlenecks and where we are having access issues in terms of patients not being able to get an appointment in seven to 14 days, which can mean we need an additional brick and mortar location. We also want to look at how we can open up our schedules to accommodate those patients."

Data drives decisions on opening new outpatient practices, she says. "There are several metrics that help us decide whether we should expand, where we expand, and what type of services we expand in a community. We look at lag time—how long it takes a patient to get an appointment. We look at the comments from our engagement surveys such as how long patients are staying on the phone. We look at our quality metrics to make sure our patients are getting high-quality care. If we see our physicians are overloaded, we often see a correlation to some of our quality metrics."