Ambulatory Care: Current Landscape & Challenges

Sonia Singh, Vice President, Center for Consumerism and Emily Davis, Analyst, AVIA

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Before the COVID-19 pandemic, ambulatory care strategy was already a critical area of focus for health systems. Their primary goals were to grow market share, ensure patient access, and deliver a positive patient experience, all while fending off a growing body of disruptors.

The onset of COVID-19 forced health systems to reevaluate all services, particularly ambulatory networks, and disrupted their existing care strategies. Systems quickly launched virtual care delivery to tackle immediate patient needs, but ambulatory care systems continue to struggle. Cancelled elective surgeries threaten margins, and ambulatory care providers are burnt out from enduring trauma and little hazard pay. 

In the fall of 2020, AVIA interviewed 10 health systems across the U.S., including academic medical centers, integrated delivery networks, and regional health systems in rural and urban markets. The conversations provided a unique understanding of the challenges facing ambulatory care networks and the emerging role of digital now and beyond the pandemic. 

The Four Challenges Facing Ambulatory Care Networks

1. Uneven volume distribution 

Uncertainty and fear surrounding COVID-19 have resulted in volume shifts across sites of care, and virtual offerings have changed how and when patients seek care. A critical challenge for health systems is how best to respond to this uneven volume distribution. 

One health system AVIA interviewed saw urgent care volume triple since March, while their retail clinic volumes lagged. Urgent care volumes have grown 200% since the onset of COVID-19, while emergency department volumes have decreased since March, with declines ranging from 45-61% across the U.S. This uncertainty around volumes has left most systems struggling to estimate demand and staff appropriately.

2. Care model uncertainty

Physician burnout was already a concern before COVID-19, and the pandemic has exacerbated the issue. 64% of U.S. physicians said their burnout has intensified during the COVID-19 crisis, while 25% of physicians are retiring earlier than they previously planned because of the pandemic. Staffing challenges and the increase in virtual care have led to uncertainty around care models for health systems, as digital has disrupted traditional care models and raises new questions:

  • What is the current demand for provider and staff time, and how will that change in the coming weeks and months? In one interview, a system that laid off clinic staff is now struggling to hire because they are competing with environments that have a lower COVID-19 risk, like specialty care clinics.
  • In a virtual visit workflow, what role does each member of the care team play? 75% of organizations report they are changing provider staffing models to optimize workflows, including blocking provider time and staffing with advanced practice providers like nurse practitioners or physician assistants.
  • How will reimbursement work with the shift to virtual visits? 73% of surveyed health systems believe pricing for virtual visits should remain at parity with in-person visits, which will be a determining factor for how much care stays virtual beyond the pandemic

3. Insufficient data for personalizing the patient experience

Consumers are looking for more from their healthcare experience. They expect the same level of seamlessness and personalization they receive from other industries. To deliver on patient expectations, health systems must have a comprehensive view of consumer data, including a unified patient record that includes social determinants of health and other non-clinical histories.

A large health system interviewed said a critical struggle is insufficient patient data and structure surrounding their enterprise data warehouse. Another regional provider is currently working to improve utilization of historical patient data to personalize the experience. They plan to implement technology to improve their call center, personalizing outbound messages and pre-populating patient information when receiving inbound patient calls. 

4. Emerging threats to volumes and growth

Throughout the pandemic, digital and non-digital disruptors like 24/7, on-demand virtual care clinics continue to innovate and remain a threat to health system volumes. One regional integrated delivery network is seeing new, disruptive entities moving into their market, so they’re seeking to recover volume and digitally compete with competitors targeting their low-acuity patients. 

While some organizations surveyed aren’t seeing disruptors emerge in their market, other health systems still pose a threat. With a shift to price transparency in progress, a lower-cost competitor is well-positioned to capture price-sensitive patient volumes for a growing list of shoppable services

Tackling Ambulatory Care Challenges with AVIA

As ambulatory care networks strive to adjust to the new normal introduced by COVID-19, AVIA is here to help. Contact the experts at AVIA for more information.