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The massive disruption to ambulatory care brought about by the COVID-19 pandemic provides the opportunity to revisit how ambulatory care is delivered and to shine a light on workflows long considered entrenched, which may not serve practices and patients as well in the future.

Many primary care offices have worked very hard to expand patient access hours. Doctor’s office hours of 9 to 5, Monday through Friday are perhaps the most obvious example of how clinical need and patient preference diverge from how care is offered in many ambulatory clinics. Data from the past decade shows the explosive growth of urgent care centers, retail clinics and use of the emergency room for primary care needs as patients sought access to care from providers other than a traditional primary care practice. Between 2007-2016, the utilization of urgent care grew 1,725%; outpacing the growth in emergency room care (229%) by seven times1. When asked, many patients cite the convenience and non-traditional hours as strong motivators to use these alternate services. With so many practices around the U.S. now constrained from providing preventive and routine care because of the COVID-19 pandemic, there will likely be a pent-up demand for primary care visits in the months following the lifting of stay-at-home orders. Now that telehealth visits have been integrated into so many practices, it seems like an appropriate time to revisit expanding operating hours on a permanent basis by extending into evening and weekend times utilizing telehealth visits.   Doing so will not only broaden access, it will also reestablish and sustain the strong patient-doctor relationship at the heart of primary care.

The COVID-19 pandemic has also amplified the need to modernize our thinking about the use of patient portals, self-scheduling platforms and open access hours to continue to drive broader access and patient engagement. Most practices are adept at educating patients about their health condition, teaching them to manage the symptoms related to a chronic condition and to identify warning signs that might indicate their situation is deteriorating. If well-informed and engaged patients can connect with their doctor in a convenient, self-directed manner, this will likely reduce the odds that they will seek care elsewhere. 

Our fee-for-service (FFS) reimbursement model further confounds the problems of patient access as it incents physicians to see high volumes of patients which understandably diminishes their ability to focus on service quality and outcomes. The current crisis has highlighted the vulnerability of ambulatory practices built solely on a FFS or productivity model.  The financial uncertainty caused by these reduced patient volumes presents an opportunity for providers to consider alternate payment arrangements that reward patient outcomes, experience of care and access.  

FH Healthcare Indicators and FH Medical Price Index, March 2018 accessed via:

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Graham Brown

Graham Brown

Senior Vice President, NextGen Advisors

Graham Brown is a principal and senior vice president with NextGen® Advisors focused on transforming care with provider organizations. His practice centers on accountable and value-based care strategy, population health management programs, and technology solutions for providers enabling new models of care delivery across the United States.

Mr. Brown is a former senior vice president and national practice leader for population health and clinical integration with GE Healthcare Partners (previously The Camden Group) where he led multidisciplinary client teams in strategy creation, program development, implementation, operations, and performance optimization engagements. He is an experienced leader in organizational development, managed care contracting, and change management initiatives.

Mr. Brown has over 25 years’ experience supporting provider groups, health and hospital systems, integrated delivery networks, and managed care payers to assess, design, contract, and implement systems and structures for population health management. He has worked nationally across the United States and Canada.

Graham completed his undergraduate studies at the University of Victoria, the Emily Carr University of Art and Design, and the Instituto Europeo di Design in Florence, Italy. He is certified in conflict resolution and negotiation by the Justice Institute of B.C. and received his Master of Public Health from the University of Rochester Medical Center.