Amid the forces of consumerism, market disruption, and changes in reimbursement, an unprecedented challenge has arisen in the development of ambulatory networks: COVID-19. Healthcare organizations are now rethinking or rebooting their ambulatory strategies in the wake of the pandemic. They are navigating decreases in elective surgeries, lab tests, and physician visits and are seeing a rapid increase in expectations for telehealth—all while acting on consumers’ demands for convenient access to more services at lower costs. Competition from inside and outside the sector, consumer needs and expectations, and the value-based care payment model have prompted organizations to dedicate more resources to ambulatory care. Has COVID-19 fully reshaped the trend to the outpatient arena, or are healthcare leaders holding the course to prevent readmissions, decrease costs, and provide a positive consumer experience?
Hospitals and health systems that want to expand their ambulatory profile are addressing multiple decisions on what service mix to offer, where to locate it geographically, and in what types of facilities to deliver it—outpatient sites on-campus or off-campus, freestanding clinics, employer- based or retail establishments, or physician offices. Developing an ambulatory network raises many complex issues that must be addressed: the best financial path forward, the impact of the regulatory environment on service provision and reimbursement, competition versus partnership, integration with the electronic health record (EHR) system, a strategic plan that includes ambulatory services, and the infrastructure required for telehealth.
Likewise, an organization with an established ambulatory platform may need to reevaluate, expand, or strengthen its offerings and locations in light of changes in regulation, payment, and competition in the continuum of care to improve its clinical and financial results. Transitioning certain services and procedures from inpatient to outpatient settings or transforming inpatient facilities for outpatient care may be other options to assess.
If all can agree that the goals are to provide care in the consumer’s desired setting and at the right price, coordinate care across the continuum, focus on population health and social determinants, provide virtual care and EHR integration among facilities, and be profitable, then how are organizations achieving these goals? The authors in this issue of Frontiers of Health Services Management lead healthcare organizations that have built successful ambulatory care programs even in the currently unsettled environment.
Robert W. Allen, FACHE, describes the transformation of ambulatory care at Intermountain Healthcare in Utah. His organization’s approach is to emphasize population health, consumer centricity, and community engagement through the development of “reimagined” ambulatory services. Important components include primary care clinics, mental health integration, telehealth, home visits, and smaller hospitals. Allen concludes, “Old ways of doing things must be changed, new systems piloted, and communities engaged. . . . The reimagination of ambulatory care is central to the future of sustainable healthcare delivery.”
In their feature article, Jan L. Bergen and Susan Wynne recount the development of ambulatory services at Penn Medicine Lancaster General Health (LG Health) in Pennsylvania. They share the vision, ambulatory strategies, and network expansion that have evolved over the years to provide care in a mix of primary care, neighborhood, community, and regional models. “LG Health leaders recognize that the bold ambulatory moves of the past were right for their time, but strongly believe that innovation and transformation are the keys to the organization’s continued success,” Bergen and Wynne write.
Commentator Amer Kaissi, PhD, of the Department of Healthcare Administration at Trinity University in Texas, shares his perspectives on ambulatory care. He reviews trends in retail clinics, urgent care, and telehealth as well as market disruptors, sound strategies, and new business models. The key is convenience for the consumer. “As newer, more convenient, cheaper, and better-performing care models emerge, the race between hospitals and giant retailers that seize strategic opportunities will accelerate innovations. Convenient care models will continue their migration from the margins to become the mainstream way of providing healthcare in the United States,” Kaissi states.
In his commentary, John J. Lynch III, FACHE, discusses the ambulatory growth strategy at Main Line Health in Pennsylvania. Consumer-centric principles drive decision-making, community engagement, and the development of options such as telehealth and virtual care for access, convenience, and a positive patient experience. As Lynch explains, “Ambulatory care begins with our patients, their knowledge of their health, and their power to access their options within their community. . . . The high stakes that our health systems currently face demand that organizations have a well-defined ambulatory strategy for patients seeking care.”
Commentator Robin Luxon, FACHE, underlines the importance of reevaluating strategies for ambulatory care services at University of Maryland Upper Chesapeake Health. She points to significant changes in healthcare, the pitfalls of overbuilding in competitive markets, opportunities for partnerships and alignments, and the vital role of technology. “With the continued seismic shifts in healthcare delivery, related to both the COVID-19 pandemic and retail giants positioning to break into and break up the traditional healthcare delivery system and models of care, healthcare systems are prioritizing ambulatory care strategy initiatives in new ways,” Luxon concludes.