Access to care has always been a stated priority in healthcare. What’s different now is that health system executives are treating it as an engineering problem that requires structural redesign, not just additional capacity.
An ambitious version of that redesign is happening at West Virginia University Health System in Morgantown, where President and CEO Albert L. Wright, Jr. is building what he calls a Health Track Hub: a centralized referral and navigation center that connects patients to the right provider before they even leave their primary care visit. The Hub uses nurse navigators, standardized workflows, and real-time data from Epic and Tableau to replace fragmented referral processes — phone calls, faxes, and lost handoffs that have defined the specialty care journey for decades — with a single, intelligent routing model.
“Our goal is to change the health trajectory of the communities we serve and that starts with making it easier for patients to access the right care, at the right time, and as close to home as possible,” Mr. Wright said.
Alongside the Hub, WVU Health has launched a unified system transfer center managing patient movement across 25 hospitals and a fully digital-enabled outpatient clinic, a pilot that performed well enough to be scaled across the health system.
“That pilot has performed exceptionally well, and we’re ready to scale that model across the health system,” Mr. Wright said.
Mount Sinai Health System in New York is pursuing a different kind of structural fix. Adrin Mammen, vice president of ambulatory patient access, described a move away from provider-centric scheduling — where patients select a specific physician by name — toward specialty-specific scheduling logic that matches patients to providers based on clinical need. The enabler is what Mount Sinai calls “provider terms”: structured clinical keywords that allow the system to surface the right provider across the network based on condition. Automated waitlists and digital self-scheduling fill open capacity in real time, reducing delays without requiring manual coordination.
“The focus is straightforward,” Ms. Mammen said. “Improve access for patients while making better use of the capacity we already have.”
Academic medical centers have their own access problem. They tend to concentrate services during hours that are convenient for faculty, not patients. Durham, N.C.-based Duke Health Integrated Practice is working to correct that. Angelo Milazzo, MD, chief medical officer, described a deliberate expansion of specialty medical, surgical, procedural and diagnostic offerings.
“Patients are, increasingly, demanding a broader array of opportunities to engage with our specialty services,” Dr. Milazzo said. “We are developing a broader selection of programs that open early and close late during the weekdays, and programs that see patients Saturdays and Sundays. This has required a reimagining of staffing models, support structures and compensation and incentives, and a shift in priorities toward being operationally flexible and capable of meeting the real needs of patients who are demanding convenience, efficiency, and frictionless satisfaction when interacting with firms in other services.”
Emergency departments represent the most acute access failure in American healthcare and some of the most creative redesign. At University of Maryland Baltimore Washington Medical Center, President Kathy McCollum implemented a rapid assessment zone that moves emergency medicine physicians and APPs into specially designed care pods in the waiting room itself.
“Not all patients end up in a bed in the main ED,” said Ms. McCollum. “Many are diagnosed, treated and released right from the waiting room. As a result, our LWBS rate has dropped significantly and our EMS offload times are now among the lowest in the state. We have also seen improvement in the amount of time it takes from a patient arriving to being admitted.”
The RAZ model proved its worth this past winter when it allowed the health system to manage a surge in respiratory illness without the overcrowding that crushed other facilities.
“The feedback from patients has been extremely positive,” said Ms. McCollum.
At Froedtert ThedaCare in Milwaukee, a Virtual Provider in Triage model extends the emergency redesign concept to multiple sites simultaneously. A physician triages patients remotely via tablet while a paramedic or nurse supports at the bedside, enabling the physician to work across multiple emergency departments without the interruptions and inefficiencies of physical triage.
“The VPIT workflow is one of the new ideas we utilize to make us more efficient through digital technology,” said John Ernst, senior vice president and COO of Froedtert Hospital in Milwaukee. “The VPIT model allows a physician to triage patients remotely. Using a tablet, the physician conducts virtual triage while a paramedic or nurse supports the process at the patient’s bedside. This format enables physicians to triage patients across multiple sites and remain focused without frequent interruptions.”
Rural systems face access challenges that urban redesign playbooks can’t fully address. At Clinch Memorial Hospital in Homerville, Ga., CEO Angela Handley is pursuing something her county has never had: a pediatrician.
“Recruiting providers to a rural community is never easy, and we have faced those challenges for years,” said Ms. Handley. “Bringing the first pediatric practice to Clinch County and expanding our ability to care for children within our hospital would be so amazing for me and my team.”
Clinch County families have driven 45 minutes each way for pediatric care for generations. Children under 12 have been excluded from hospital admission because the infrastructure to care for them wasn’t there.
“This is more than a new service line,” she said. “It is an opportunity to fundamentally change access to care for the children and families we serve.”
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