About 15 years ago, a health systems strategy for financial success typically involved optimizing fee-for-service structures. This meant it was key to have good contract negotiation on high fees for service rates, but no risk sharing was involved. But things have changed. Health systems no longer make substantial contribution margins in this way. Most systems have shifted to encompass a value-based care model as the primary driver of revenue for the system. Now health systems rely on patients coming in for preventative care, and paying premiums. In the best-case scenarios, health systems then profit from leftover money from premiums.
Regardless of the relative mix of fee-for-service (FFS) to value-based care (VBC) revenue, one thing remains a constant for success; the need for seamless access to subacute care for same-day/next-day needs. Retail-focused urgent care platforms are growing in popularity as a mechanism to drive revenue for health systems regardless of their position in the VBC market.
Urgent Care and Health Systems
Using urgent care as a top-of-funnel patient acquisition strategy makes sense in the case of a VBC contracted patient (they stay in-network, are kept of emergency department, and treat early in process, etc.).
Having a solid same-day/next-day strategy also helps in FFS contracted arrangements. For example, a seamless way to capture patients requiring downstream procedures is critical in systems trying to help subspecialists keep the operating suites full.
We all know the pendulum is swinging from a primarily FFS world, into a world more dominated by contracts that demand shared risk. While many parts of a health system find challenges in building up strategic operations to be successful in a ‘blended world’, the reality is that only in frictionless on-demand service settings can you solve the problem of new patient acquisition and reduce patient leakage.
And it just so happens that, urgent care centers are ways to increase the top of the funnel and reduce leakage for systems—supporting each financial model.
Building a healthy top of funnel
The dilemma when it comes to patient acquisition that every hospital and health system has is, do I build to optimize for a fee-for-service, or do I build to optimize for value-based care? The rub exists when there are financial incentives that contradict each other coming from each model. In a retail urgent care setting, they can accomplish several goals that serve each model well:
- Lower cost total cost of care: frictionless access to centers designed to keep folks out of the emergency department.
- Offer preventative services: when properly leveraged, these centers can then be tweaked to offer preventive services that comply with HEDIS criteria
- Refer more patients to specialized services: patients with acute needs that are procedural based, can then be referred to higher levels of definitive care.
In any type of FFS arrangement, these retail-based, top-of-funnel platforms, drive revenue and margin for the system.
Attracting Patients that need your services
On average at Solv, we see that patients searching for urgent care are 35-45 years old, female, with two kids. Oftentimes, these patients aren’t necessarily connected to a health system because they are healthy and handle health needs on a basis-by-basis manner. Which can mean little to no connection with primary care. In fact, in our state of patient engagement report we found that 35% of patients are interested in getting annual physicals, and other primary care services on-demand.
In some studies, up to 50% of patients seeking care at an urgent care consider themselves devoid of a PCP relationship. For health systems, this is an opportunity to connect with new patients, assign them a PCP, and bring that patient into the health system for the long term.
Utilizing appropriate services
A great place to triage complex patients with chronic medical issues is an on-demand center. While many exacerbations of chronic disease require admission and inpatient treatment, some just need a good clinical evaluation, appropriate communication with the care team, and expedited output follow-up.
Avoiding an unnecessary ED with such a simple strategy is great for the financial health of an organization. Some studies show over 50% of what comes into an ED for care can be effectively managed in an urgent care setting.
Reducing patient leakage
Once you have acquired a new patient into the system, most contracts financially reward the provider for managing the care within the network, at the most appropriate care setting. So, a key aspect of any health system strategy is reducing patient leakage. Given that within a few years, many people change insurances, move or make other changes that impact the ease of access to healthcare, systems must constantly build the funnel as well as work to maintain current patients in the system.
As you can see, a well-oiled urgent care platform works to deliver the bottom line health systems are looking for in a world of mal-aligned incentive plans that systems have to deal with. Whether a FFS patient or one with a Medicare Advantage plan, systems extract value in both instances by having a robust retail platform.
Followup after telemedicine
While telemedicine programs are great resources for patients, and provide more opportunities for systems to connect with patients, the end of a telemedicine visit often leaves patients on their own to take the next step towards care—for example, go seek additional help, go get a lab test, etc. But where to send a patient that isn’t at risk of leaking to a different system?
Urgent care is an agnostic option for the often-needed quick follow-ups after telemedicine visits.
Providing on-demand care
When Solv asked patients how long they would wait to see a provider of any kind, 26% of patients said they would not wait longer than a day. By providing on-demand care through urgent care you give those patients access to same-day care.
Creating sustainable growth
By using urgent care centers for top-of-funnel and prevention of patient leakage, it becomes a layer of protection for both models of care.
Once you build that funnel, you have this system that's designed to push people out into the system and offer them the right services.
You can capture patient issues and medical problems, and use urgent care for basic services, but even more complicated services like pre-op exams, to funnel directly to specialized services.
LinkedIn
