UMass Memorial proves access to clinical care is key to good patient outcomes

The efficacy of care delivery centers, whether hospitals or clinics, is driven by ensuring patients get the right treatment at the right time at the right locations. Consequently, developing infrastructure, processes, and metrics that matter is critical to constructing a patient access center (PAC). A PAC will enable seamless patient communications, schedule appointments, refer patients to clinicians, and support the overall financial needs of the hospital. That is exactly what UMass Memorial Health created with support from EY; the PAC delivered results surpassing its goals for the ambulatory setting. This partnership can serve as a roadmap for other hospitals and healthcare providers.

UMass Memorial Health is a regional health system serving central Massachusetts; it is also UMass Chan Medical School’s care delivery partner.

Centralized patient access is critical to ensure patients receive the right care at the right time

The COVID-19 pandemic was horrific. It took more than a million lives in the US and approximately seven million globally. The tragedy highlighted critical opportunities for delivering care, leading to creative initiatives such as standing up nurse triage facilities and COVID-19 treatment centers that ensured those affected by the virus had access to the right care.

We can’t take care of our communities, and we certainly can’t grow if we don’t provide our patients with the right provider for the right reason at the right time.

– Dianna Caffarena, SVP Ambulatory, UMass Memorial Medical Center

UMass Memorial already had systems and processes centralizing many patient access functions, including financial clearance (claims, billing), appointment scheduling, and referrals management. Yet, the outcomes included extremely high patient call abandonment rates, low referral conversion rates, and sub-optimal scheduling, suggesting that the patient access functions did not reflect industry-leading practices. The systems and processes needed attention, and some needed to be re-engineered.

Additionally, the patient access system’s performance during the early stages of the pandemic highlighted some opportunities that inspired UMass Memorial leadership to commit to creating an industry-leading patient access center.

Centralization is key to an industry-leading PAC

UMass Memorial decided to design and build, in partnership with EY, an industry-leading PAC based on processes established by leading providers, EY’s outside-in perspective, and patient feedback. The primary design thesis was to identify and centralize key functions to maximize consistency, scale, and resource optimization (financial, people, and infrastructure). UMass Memorial deliberately distributed its care delivery facilities across central Massachusetts to be closer to its health consumers. It considered centralizing the PAC critical to achieving the outcomes it sought.

EY and UMass Memorial’s collaboration developed a solution with three core characteristics:

• Data-driven operating model: Data-driven decision making is central to the operating model. The future state of the clinical and patient access operating model leverages data-driven decisioning to be central to operations able to achieve the desired outcomes.
• Streamlined processes: The team standardized PAC workflows, including scheduling, patient referrals, financial clearance, and clinical workforce management. The standardized processes also define omnichannel communications with patients to drive improved and consistent interactions.
• Integrated digital enterprise: The team identified and integrated various technologies (CRM, EMR, telephony) to support the new operating model and centralized processes. It also laid the foundation for the digital front door UMass Memorial is developing to expand its reach.

The team organized the implementation approach by workgroups, defined by department and specialization, to mitigate risk and limit disrupting care delivery. These workgroups transitioned to the new PAC in three phases over 18 months.

Any enterprise transformation is challenging, but academic medical centers typically present different challenges, given the autonomy of department chairs. EY has extensive experience managing change. Its change management approach included all stakeholders, used data to help drive decisions, and built trust through incremental outcomes; the approach was crucial to achieving timely results.

A health system can meet its goals by meeting the needs of its patients

UMass’ outcomes-driven approach to building its PAC proved effective. Many of the project’s outcomes exceeded objectives for effectiveness and timing. Exhibit 1 showcases sample outcomes achieved across the key dimensions of improving patient satisfaction, centralizing operations to improve efficiencies, and growing the health system.

Exhibit 1: UMass and EY have made tangible improvements across the dimensions of the growth of the health system, patient satisfaction, and operational efficiencies

Data: EY
Source: HFS Research, 2023

The Bottom Line: Expert partners and committed leadership are critical to ensure patients can access the right care at the right time.

A key attribute of the success of transformation efforts tends to be the sustainability of the outcomes achieved. A key tenet of sustainability is long-term ownership of the solution and outcomes. While EY and UMass Memorial collaborated on the design and implementation, UMass Memorial is beginning to own the PAC. As EY executes the PAC’s later phases, there is a clear process established for transitioning control to UMass after achieving the outcomes. The design and implementation of the UMass Memorial solution reflect a good and practical approach to delivering outcomes that matter.