8 hospital executives share outpatient strategy — ASCs, retail clinics, key partnerships & more

Hospital and health system leaders across the country are evaluating outpatient strategy to match the value-based, consumer-focused trends in the healthcare industry. Here, six hospital executives discuss their institutions' outpatient strategies and how they plan to grow in the future.

Barry Arbuckle, PhD. President and CEO of MemorialCare Health System (Fountain Valley, Calif.): "MemorialCare has been preparing for healthcare's transformation into community-based, outpatient care for decades. Our growth and diversification from a hospital system to an integrated and diversified healthcare delivery network gives us a unique competitive advantage. With five hospitals and 200 outpatient physician, urgent care, imaging, kidney dialysis and surgery center sites stretching over a wide area in Southern California, we are uniquely positioned to provide consumers with high value health, wellness, prevention, chronic disease management and treatment in the right location, with the right services and at the right price. Our ambulatory centers are intentionally not operating under the hospital license as an HOPD, therefore, affording considerably more value for employers, payers and consumers. And we are unveiling even more new healthcare centers, innovative programs, progressive partnerships and comprehensive services — located near where people live and work."

Gary Brock. Executive Vice President and Chief Integrated Delivery Network Officer of Baylor Scott & White Health (Dallas): "Today, if you look at Baylor Scott & White Health as an enterprise, we have 1,011 different sites and 956 are outpatient ambulatory assets. Our outpatient strategy is part of a coordinated consumer strategy. We want to be more accessible to the consumer in their communities. We want to see patients close to home when they want to be seen.

In addition to our investment in physician clinics, retail clinics, urgent care locations, ambulatory rehabilitation clinics, outpatient surgery centers, short-stay surgical hospitals and freestanding emergency hospitals, we are also investing in digital solutions. We have synchronous and asynchronous capabilities that we've launched and we've created a direct home visit care program. In this program, you can use an app on your phone to speak with an advanced practice provider. That APP can dispatch a provider to your home and do home visits. Our plans are to be available 24/7/365.

Another important issue is if a patient comes from some miles away to Dallas to have a procedure done, we can follow up with the patient digitally instead of requiring them to drive back to Dallas. We are doing quite a bit of that right now with patients from various locations, including portal visits to follow-up instead of having them return to the city, unless it is necessary."

John Bulger, DO. Chief Medical Director of Population Health of Geisinger Health System and CMO of Geisinger Health Plan (Danville, Pa.): "We are focusing on understanding populations and wrapping our arms around the most ill while ensuring that we provide for the basic needs of all. We are paying particular attention to advanced analytics and team-based, collaborative care. We are partnering with our patients to provide real time access to compassionate healthcare close to home."

Gerard Colman. COO of Aurora Health Care (Milwaukee): "As is true of many health systems, outpatient care is a growing part of our care delivery strategy. We recently opened two large outpatient facilities covering multiple specialties in Germantown and Burlington, both near Milwaukee, and recently announced plans for another such facility south of Milwaukee in Kenosha. We've also expanded our behavioral health outpatient facilities across our footprint, recognizing the value it brings in patients' overall health.

At the same time, we recognize outpatient locations aren't always the answer. To that end, we recently announced plans to build a replacement hospital in Sheboygan, and are also exploring innovative technologies such as electronic and virtual visits. In all of these efforts, we want to make sure our patients have easy access to the right care in the right place. Additionally, we're working to ensure our patients experience coordinated care that's delivered in the most efficient way possible, to make the best use of our resources."

Laurence Merlis. COO of Jefferson Healthcare (Philadelphia): "Jefferson Health is setting a bold aspirational goal of creating an ambulatory footprint over the next 10 years that assures a Jefferson provider is within five miles of every consumer in its multi-state (Pennsylvania, New Jersey and Delaware) service area. Our goal is to deliver the high quality care that patients expect from Jefferson when, where and how they want it.

Jefferson's strategy for the future is based on a multi-pronged approach including: a robust on-demand and scheduled visit telemedicine platform, partnerships with retail pharmacies to operate clinics run by nurse practitioners; telehealth enabled 'booths' in malls and shopping centers staffed by medical assistants; primary care practices with sunrise, evening and weekend hours; ambulatory surgery and endoscopy centers providing lower cost care for lower acuity procedures; and regional, comprehensive 'one-stop shopping' ambulatory care centers that provide primary and specialty care, as well as diagnostic and treatment capabilities.

In developing its strategy, Jefferson moved away from the traditional view of primary service areas which is based on where the majority of hospital discharges come from, and looked to the success of the retail giant, Target, to create 'target areas' for growth and expansion. The approach is data-driven and recognizes that healthcare providers must respond to consumer expectations of convenient care, close to home.

Jefferson realized that relying on HOPD rates and building a facilities strategy around those rates has limited long-term utility. The location of Jefferson Health's newest ventures, a comprehensive cancer center and a large multispecialty ambulatory care center, were selected based on their ability to penetrate new geographies, not on proximity to its hospitals in order to take advantage of HOPD rates.

Jefferson is also partnering with physician groups to operate ambulatory surgery centers and currently has full or partial ownership in seven ASCs and expects to add more in conjunction with physician partners."

Lee Penrose. COO for Acute Care Delivery with St. Joseph Hoag Health (Irvine, Calif.): "Many hospital systems view ambulatory care as separate services from inpatient care, but at St. Joseph Hoag Health, we see outpatient services as a critical component of our integrated network of care. Connecting our care and services is part of our overall approach to achieve our goal of more accessible care, which for us means making care more convenient and meeting patients where they are. New technologies and advances in medicine have historically driven services from the inpatient hospital setting to the outpatient environment. We embrace this trend and see it as a significant part of the solution to create affordability in healthcare.

As an integrated health system, our network of services includes everything from primary care to intensive inpatient care. We leverage this connectivity to track and improve patient outcomes for services from treating the common cold to treatment for heart attack and everything in between. Our robust database of healthcare data combined with our exceptional roster of clinical expertise comes together to help people take a proactive approach to their health in their everyday lives. With advancements in technology and medicine, we are seeing more procedures in an outpatient setting that historically would have been done exclusively in the hospital. We embrace this trend as an enabler of affordability.

The establishment of outpatient centers has been a key to the development of our network. We are continually re-thinking our approach to outpatient service offerings. Outpatient surgery is expanding and outpatient surgery centers are proven to be a more efficient place to care for patients. So we are continually looking for ways to expand access to affordable outpatient centers. Similarly, our urgent care network is expanding as an in-between point of care for those who can't wait for a primary care visit, but don't need to visit the emergency room either. Along those same lines, we’ve also placed a major emphasis on wellness, opening Wellness Corners in workplaces and retail locations across the county that offer those services most needed in their neighborhoods."

Johnese Spisso. President of UCLA Health and CEO of UCLA Hospital System: "Over the past year at UCLA Health, we've been focusing in on continued expansion of our primary and secondary care network. Our goal is to place UCLA healthcare conveniently throughout the greater Los Angeles area to provide high quality, cost-effective care. In some areas, we have been adding select specialty care to clinics with the same mindset. Our goal is to provide care in the most efficient setting. Our hospitals are focused on the more complex inpatient tertiary and quaternary care our patients need.

Because Los Angeles is a large metropolitan area with issues like heavy traffic, it's important for us to go where the patients are. As part of that strategy, we operate about 160 clinics in about 70 different locations throughout Los Angeles that include primary care, urgent care and select specialty care as well. Since 2010, UCLA Health has opened or will soon open outpatient facilities in about 50 new locations throughout the Los Angeles region.

The clinics are a combination of properties we own and lease. We staff them with UCLA physicians and staff, as we've found our draw from the patients is the UCLA brand. We also have select partnerships with community hospitals near our clinic locations that can provide a secondary level of care. The community hospitals are staffed with UCLA hospitalists to provide that care.

In some areas, we have outpatient surgery and procedure centers as well. Some of these centers we own and operate ourselves and a few are joint ventures. We see these centers becoming a bigger part of our outpatient strategy in the future because patients like the convenience and it helps us reduce the total costs of care while demonstrating a value-added service.

Right now, we are concerned about what will happen with the ACA. In California, the ACA expansion provides coverage to 4 million people and we're looking at how new health policies will impact our strategic plan going forward."

David Strong. President and CEO of Orlando Health: "In our market areas, we are positioning our ambulatory assets in a manner that is highly consumer oriented. Starting from a comprehensive set of analytics, we have worked with our team members, physicians and leadership to develop across our different markets, specific tactics that tailor our various types of ambulatory assets (urgent care, ASCs, diagnostics, primary care practices) to the market need. It is our intent to greatly enhance our customers' ease of use of Orlando Health services.

While the rise of consumerism and the adoption of telehealth have been slow in our market to date, we believe that these forces have significant impact in our market long term."

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