The journey to value-based care: A new value chain for patient access centers

At the outset of this journey, access centers run as siloed operations characterized by higher operating costs and contributing to a fragmented patient experience. However, as access centers mature, we’ve seen their journey develop alongside complimentary capabilities that span the health system and its many consumers, ultimately revealing a powerful tool in the journey to value.

An observed pattern

At the most fundamental level, access centers generally run as siloed operations leaving the overall experience inconsistent in both quality and output. Call abandonment, wait times, and low employee engagement are common pain points felt by both patients and employees due to the disconnect between these centers and broader operations.  When systems attempt to address these pain points and foundational challenges, improved call resolution and routing to specialized roles and skillsets are often the first enhancements. 

Access centers then move to addressing primary care and specialty scheduling, as well as pre-service registration to improve  patient flow and downstream collections. In parallel, health systems will often establish a patient portal or mobile application in support of improved scheduling and collection, yet success has been limited. Unstandardized provider schedules fuel a persistent need to ultimately drive patients back to call centers for nearly all scheduling requests. Despite the promise of portals, self-service scheduling remains a challenge. From this point, systems generally focus on standardizing provider scheduling preferences and other critical functions are slowly added to complete the patient and provider experience for referrals, pharmacy, and nurse triage. Despite these targeted enhancements, most interactions with access centers remain inbound and reactive.

As a siloed operation, access centers remain the primary channel for communication between a health system and their patients. However, as new channels like interactive voice response, instant messaging, and self-service portals/mobile solutions are incorporated, access centers start to look like a “connected hub.” Outbound communications start to occur in the form of reminders, call backs and care management. At this point in their evolution,  we find that these new levels of access actually lead to greater call volume and require high capital investment and operating expenses, ultimately yielding a net negative cash flow. However, if access center savings  and revenue lift from improved patient flow and collections are pursued, net cash flow will begin to trend positive.

Rethinking patient access center

In our view, the access center journey culminates in a highly personalized consumer experience (patients, providers, patients’ social networks, referring providers, pharmacists, and payers) moving from episodic transactions to a more sustained, personalized relationship. As access centers advance toward personalization, financial returns simultaneously climb out of the investment valley. In our view, this is not the end of this journey. Rather, personalization is the start of a foundational capability that can transform a health system through a truly integrated care and engagement model among patients, multiple providers, payers, nurses, and care givers.  This new integrated  model simultaneously adds value to the consumers while affording the health system the ability to bear and successfully manage financial risk. In this new view, patient access centers are a set of capabilities that can accelerate a health system’s journey to value for all consumers.

To reap these benefits, health systems must first determine how they will operate across two dimensions (consumer experience and financial risk management) and three investment-based profiles (value, sustainable, concierge). (Figure 2)  Each profile determines the maturity model required to transition to this new vision of patient access and guides payment model transformation from fee-for-service to value-based care. Once an operating zone has been selected, the underlying capabilities can be developed in a strategic sequence.

A new value chain 

In the new patient access center value chain, the access center becomes a more digital asset, enabling patients and providers to utilize multiple channels to gain access to administrative and clinical functions.  As the access center matures, it begins to deepen and augment the bookend functions that commonly occur during patient visits – pre and post-care functions. Each of the functions in the value chain are evaluated as being one of the four stages – Siloed, Connected, Personalized, and Integrated.