Academic Medical Center Transforms Business Operations and Patient Access
This large academic medical center launched a multipronged approach to achieve systemwide transformation amid a changing financial landscape.
As the only academic medical center in its state, this organization treats many of the state’s most complex medical conditions and is also a safety net provider of high-quality care to all residents, including underserved populations. While the costs of caring for its patient populations were rising, reimbursements and grant funding were shrinking.
The organization was also challenged by inefficiencies and variation that occur in a large complex organization. Areas of the business were operating on different, often incompatible systems, which negatively impacted communication, collaboration and business functions throughout the organization. A lack of reporting tools and governance structures had increased labor costs while missed opportunities in supply chain management contributed to higher operating expenses. Clinical inefficiencies put a strain on inpatient capacity, which increased length of stay and overwhelmed the emergency department. This also created multiple barriers for outpatient access to care. Additionally, the absence of a mature approach for collecting, analyzing and sharing data prevented leadership from making informed, strategic business decisions.
Leaders understood that to continue fulfilling its mission in a difficult financial landscape, the organization would have to become more efficient and accountable systemwide. Teams needed to reduce costs, increase revenue and improve access to care.
The organization’s leadership and Huron designed a strategy to break down departmental siloes, integrate business processes, and expand and streamline consumer access to care. Across multiple departments, the teams focused on improving efficiency and productivity, enhancing teamwork, reducing variation and strengthening patient financial services, all of which would ultimately drive revenue and contain costs. Core improvement efforts focused on:
Enhancing revenue. Revenue cycle operations presented multiple opportunities for improvement. The organization and Huron developed a reporting program to capture key financial and staff performance metrics, enabling the organization to identify and mitigate breakdowns in the revenue cycle process. The teams also restructured critical revenue cycle functions to eliminate siloes, reduce work in progress (WIP) backlogs and increase collaboration between key financial departments.
The teams also designed and built the organization’s first specialty pharmacy with Utilization Review Accreditation Commission (URAC) accreditation. The specialty pharmacy included a payor network access strategy as well as patient care management tools and techniques to drive maximum usage and provide an additional revenue stream.
Improving payor relationships and clinical documentation. The teams redesigned and implemented a fully functional clinical documentation improvement program and staffed it to the qualifications of preferred payors. Both providers and staff received training to ensure documentation was appropriately completed.
Managing expenses by optimizing supply chain. By insourcing certain supply chain functions that were previously outsourced, and renegotiating existing outsource agreements, the organization and Huron were able to generate significant cost savings despite bringing on new staff members. Additionally, the organization’s leadership and Huron formed teams dedicated to developing and implementing cost reduction initiatives for supplies across all service lines and pharmacy operations.
Utilizing technology to align leaders, clinicians and staff on organizational functions. After developing custom governance structures for various departments across the organization, the organization and Huron implemented tools to support enterprisewide productivity and workforce management. These tools informed the organization of appropriate staffing and skills needs for both anticipated and actual volumes.
Removing barriers to care. Addressing ambulatory inefficiencies and consumer access to care, the organization and Huron were able to increase outpatient visits, decrease cancellation rates, reduce scheduling lag for new patients and improve provider visit completion. Executed initially within neurology, urology, primary care and pediatrics, optimization and standardization across people, processes and technology were then expanded to other specialties and clinics.
Increasing accountability for collecting and utilizing data. The teams identified key sponsors to join a governing committee dedicated to building a data-driven, high-performing culture. This committee was tasked with reviewing sources of data, investigating validity and defining key performance metrics to drive decision making. Processes were put into place to support data accountability through weekly metric reviews that included service line leaders and key executives, with a focus on continuous improvement.
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