A Multipronged Approach to Improving Patient Access

 

In FY24, Johns Hopkins Community Physicians (JHCP) provided care or health assessments to 280,000 unique patients during nearly 1 million patient encounters across 58 practices in 38 locations. 

Matching every patient’s need for timely, appropriate care with available provider resources is both difficult and vitally important. High-quality access is tied to patient satisfaction, patient wellness and payer outcomes.

Working to improve patient access has become a particular JHCP priority over the past few years, as patient volume has grown and as patients are returning to in-person appointments after a transition to virtual care during the COVID-19 pandemic.

Melissa Blakeman, internal medicine physician and medical director for patient access, is working with colleagues on several initiatives to increase patient access.

One key way to improve access is to hire more providers. Recruitment this year was at an all-time high, thanks in part to a boost in physician salaries and a commitment to protecting administrative time to help create capacity for the high volume of non-face-to-face work.

Additionally, new providers joining the team are now expected see a full patient load within three months — a goal that is made clear during the interview and onboarding processes.

“We didn’t have a specific expectation before,” Blakeman says. “Everybody knew that new providers had a year or year and a half until they were responsible for their own productivity, so it depended on each provider to determine how fast they got to a full day’s schedule of seeing patients. We’re really fortunate that we had a lot of new providers start this year — 40 — which is fantastic and further opens our access.”

Blakeman is now reviewing appointment templates, which are the electronic version of a schedule book. When patients call or message for appointments, scheduling decision trees ensure that the right provider, visit length and appointment type are created. The templates make sure there is capacity for those different appointment types, while building in time to handle acute appointments at every site.

In the past, Blakeman says, there were no standards for these templates, and there was nothing to prevent well-meaning office staff from tinkering.

About two years ago, JHCP tapped the Template Center of Excellence, which is staffed by certified template builders who build and maintain templates for the Department of Medicine, to do the same for JHCP.

The result is a system that is improved and standardized across JHCP practices, she says. “And if there are new initiatives or anything to change, we can more rapidly pivot because we have a dedicated group of people who know what they’re doing.”

JHCP also supports Johns Hopkins Medicine’s plans for growth in ambulatory care, particularly for areas in the National Capital Region surrounding Suburban Hospital and Sibley Memorial Hospital, says Kate Waldeisen, executive director of strategy and value-based care. The organization was first to market with primary care in McLean, Virginia, for example, and actively supports ambulatory center needs such as primary care and specialty hires.

In another bid to increase access, practices are reserving some appointments for young adults aging out of pediatric care, to help them establish relationships with family medicine and internal medicine providers.

JHCP is moving toward value-based care arrangements, in which health care entities can be reimbursed by the Centers for Medicare and Medicaid Services or commercial payers based on results of the care they deliver to patients. Specifically, Waldeisen says, they are entering into novel payment structures such as those involving shared savings, in which provider groups that give coordinated, high-quality care while spending health care dollars wisely, may be eligible to share in the savings they achieve. These activities are coordinated through the Johns Hopkins Clinical Alliance, a clinically integrated network.

JHCP also participates in the Maryland Primary Care Program, the largest Medicare advanced primary care program in the nation, and as such, maintains access for annual wellness visits for beneficiaries covered by Medicare and for annual preventive care visits for all patients over 65, regardless of insurance carrier.

“All of the delivery of patient outcomes is completely underpinned by access,” Waldeisen says. “If we don’t have access, we really can’t deliver on providing care to the patient, and meeting the patient outcomes we desire to achieve.”