The Role of Ambulatory Networks in Hospitals' Population Health Efforts

Mayo Clinic, Cleveland Clinic, Johns Hopkins. When most people think of healthcare, it's systems like these and others that usually come to mind. In the future, however, that may change: The names of primary care offices, urgent care centers and other outpatient facilities may become the equivalent of "healthcare" in people's minds.

Mark CoughlinThe shift from outpatient to inpatient care: Why?
Three main forces are shifting healthcare systems' focus from inpatient to outpatient care:

1. Patients are seeking more convenient access to healthcare services. They want facilities that are geographically close and open after work hours.

2. Payers are demanding lower-cost settings of care. Urgent care clinics and retail clinics can provide some of the services of an emergency department at a fraction of the cost, making them more attractive to both patients and payers.

3. Providers are attempting to manage population health. Ambulatory care sites allow providers like hospitals, health systems and physicians to more proactively manage chronic conditions, prevent serious illness and improve overall population health.

"Ambulatory networks will eventually supplant hospitals as the hubs of successful healthcare organizations," says Mark Coughlin, senior vice president of advisory services at Hammes Company. "Historically, everybody focused on hospitals as one of those defining features. I think ambulatory networks are going to become the critical defining feature in the future."

In fact, this shift in the industry from inpatient to outpatient care has been occurring for quite some time. It's only relatively recently, however, that hospitals and health systems have started integrating their ambulatory offerings, according to Mr. Coughlin. "In the past, as that volume moved to the outpatient arena, it moved in a very disjointed fashion, with a lot of small, standalone operators in that space, and hospitals in that space, but not as significantly as they could have been," Mr. Coughlin says. "What we're seeing now is a continuation of that shift, but we're also seeing more emphasis on integration."

Managing population health
This integration of ambulatory facilities is necessary for hospitals and health systems attempting to manage population health. For example, primary care offices can provide wellness services through yearly checkups and follow-up care after hospital discharge, and retail clinics can provide preventive services such as flu shots. Urgent care centers, which treat minor injuries, can refer patients to primary care offices for follow-up care. "If hospitals want to be leaders as they evolve to true health systems, they have to develop the biggest missing component of the continuum, which is the ambulatory network," Mr. Coughlin says.  

Connecting outpatient sites through electronic medical records and aligning incentives can help providers coordinate services to best keep patients healthy and out of the hospital.

Balancing inpatient and outpatient care
The goal of population health is to improve the community's overall health, preventing serious illnesses and injuries that require hospital care. If hospitals and health systems succeed, they will have to plan for less inpatient care demand. Evaluating the population's demographics can help organizations plan facilities for future capacity needs. "Trying to find the balance between the ambulatory network and the population it serves and the appropriate level of acute-care services to meet population demand is going to be one of the biggest challenges for providers in the future," Mr. Coughlin says.

He suggests conducting scenario planning by developing likely events in the market and potential reactions. For instance, hospitals and health systems could plan for a decrease in inpatient utilization of a certain percent and an acquisition of a competitor. "Try to understand potential scenarios so you have a course of action already laid out for whatever happens. That is the best way to be prepared for the uncertainty we're all facing," he says.

More Articles on Population Health:

4 Questions to Ask Before Adopting an Ambulatory Network Strategy
5 Myths Surrounding the Business of Population Health Management
Employer-Sponsored Health Clinics: What Hospitals Risk if They Don't Get Involved

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