Doing more with less amid the Great Resignation: Using data to boost patient access with fewer provider available hours

Part of the New Mexico division of Ardent Health Services, Lovelace Medical Group (LMG) is a multispecialty group in Albuquerque that employs more than 200 providers. In the summer of 2020, LMG faced a grim reality. COVID-19-related quarantines kept patients away from clinics, elective procedures were canceled, and primary care providers who were already experiencing burnout were required to modify their care delivery to survive.
 
In warp speed, LMG launched a telehealth service in early April 2020. However, the providers' scheduling templates had many blocks reserved for various visit types. Telehealth was not only a new visit type; it was also a new service delivery method that required schedule adjustments to allow providers to easily switch between seeing patients in person to televideo, with only the slightest disturbance to clinic operations.
 
The group's first step was to open scheduling templates by removing most of the blocks from provider schedules. This allowed accommodating televideo appointments at certain times, allowing patients to schedule appointments online and ensuring patients received the best service at the clinic. Self-scheduling heralded the group's adoption of a digital front-door strategy, which initially focused on connecting patients to care through digital channels such as online and patient portal scheduling.
 
LMG implemented the Epic EHR in April 2017. Yet the company had never utilized the scheduling module in a way that realized its full potential. Hence, the Epic scheduling module was identified as ground zero for the change required to improve scheduling, increase patient access and maintain revenue flow during difficult times.
 
After removing most blocks, the provider scheduling templates were designed to fully utilize the ambulatory enterprise's most prized possession, provider available hours. Templates were built to support 10-/20-minute or 15-/30-minute appointment durations to reduce the chance of gaps in the schedule. Visit types were associated with the provider, patient age range, and limit of visit types per day, and scheduling instructions were uploaded for each visit type for each provider. This resulted in a substantial reduction in scheduling errors, more scheduling slots and an increase in provider, patient and staff satisfaction.
 
Between summer 2020 and fall 2021, LMG experienced an unprecedented rate of provider resignations. The group lost more than one-third of its primary care workforce. This was not unprecedented, as other healthcare systems in New Mexico have experienced the same resignation wave.
 
When life returned to a new normal, patients found themselves waiting a few months for an appointment with their primary care provider. However, the fact that other health systems faced the same challenges only motivated LMG to find innovative solutions to deliver timely care to their patients, while also achieving a competitive advantage.
 
Access management was born as a new discipline under business operations and aimed to optimize provider scheduling templates to increase patient access. Access management is a combination of a Lean model that attempts to improve a process by eliminating waste and utilizing tools and resources an organization already has to deliver optimized value to the customer, while improving the bottom line.
 
Parallel to work related to access management, the operational analytics team developed reports to identify opportunities, design strategy and support the decision-making process. Due to optimization of the scheduling templates, LMG was able to automate the third-next-available appointment (TNAA) report in Power BI and started using it daily across clinics to find available slots and call patients scheduled for later dates to offer an earlier appointment. The report also helps identify anomalies with templates that may decrease access. The weekly block utilization Power BI report measures how blocks are utilized and to what degree, and provides insights related to the number of blocks the clinic/provider needs to use. The monthly no-show report indicates the provider's daily no-show number and allows the clinic to double-book appointments to this number.
 
LMG uses additional metrics to measure the impact of access management on patient access. During the past year, schedule utilization metrics such as percentage of available hours scheduled, percentage of available hours completed, number of double-booked appointments, and lead time (duration in days from an appointment request until appointment date) were monitored monthly to identify gaps in process and opportunities to improve access and productivity.  

LMG TNAA Power BI trend report

Thanks to the implementation of access management and advanced reporting, LMG successfully mitigated the shortage of providers while increasing patient access and securing its bottom line by optimizing its current tools and resources.

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               LMG block utilization Power BI report