Well Health, formerly Spectrum, and then Alan and Danielle from Lehigh Valley Heart and Vascular Institute. So thank you all for joining today. We're going to get started here. We've got lots to cover and just to orient everybody to the screen. At the bottom of your screen, there is a chat box and a Q&A box. In the chat, you will find links to the presentation, so please download it there. On the Q&A box, please submit any questions you have. We will monitor this during the webinar, and we will have some time at the end of the webinar for open discussion and questions, so please utilize this Q&A. And if we don't get to all of them, no worries, we will follow up afterwards. So these are our disclosures, and let's get started. So the reason we're here today is to talk about patient and access management. So a lot of you probably have seen some activity on the Listserv, and we heard a lot of need for this discussion, so that's why we're here. We did break it up into two sections. So this is the patient referral and access management, and next week we'll talk about provider scheduling. So why is this so important? It's important because we know that cardiovascular programs who optimize APP utilization and team-based care can really meet the goals of the quadruple aim and be successful. There's no shortage of challenges. Mainly, we see a lot of lack of established parameters around patient access. So what's the consequence? This can lead to the wrong patients being scheduled in the wrong slots. Think about maybe you have dedicated EP slots, but you get an urgent work-in in that slot and it's not utilized correctly. So we want to make sure we're getting the right patient in the right slot. Other challenges may be rigid templates and individual preferences. So what's that consequence? That's going to be something like, well, I have to be out of the office. I have a full clinic schedule in two days. Now we're canceling those appointments and rescheduling them for several weeks out. Other challenges include our APPs that we're hiring because we need more support, but we're not really leveraging them and working them to the top of their licensure. So what is your culture? Do you trust and build that relationship and work with your APPs or are they just acting more of a kind of a care team member? So how are you utilizing them? What are you focusing on? Is it individual production and volume? We really want to make sure we're looking at quality and team metrics and not so much encounters and volumes. What is your culture? Is it a culture of no, meaning we're not really working around the patient? We think we are, but we're really accommodating providers and preferences over the patient. We really need to shift that to a culture of yes and make accessibility to patients more readily available. And then are we adequately supporting our clinics? So beyond the APPs, beyond the providers, who are your support staff? Are you leveraging MAs, nurses, and non-clinical team members? All of these components have to come together to make this part work well. So when we think about referral management and patient scheduling, that's the beginning of the pathway for our patient and the care continuum. So referral management has to do a lot with accessibility. Are you getting the right patients in? What is the availability in that referral process? Is there open communication with providers and a clear understanding of what those referral kind of guidelines or criteria are? Is there shared decision making? And this is important because you may be getting inappropriate referrals and that patient maybe not, maybe doesn't need to come to a heart failure specialty clinic. And are you communicating that in a professional manner back to the provider who sent the referral? And around scheduling, are you, what is your timeliness? What kind of appointment types do you have? We're seeing more and more appointment types. Do you have quality appointments such as heart failure follow-up appointments? Are you, do you have enough new patients? You've got to have enough new patient appointments. Do you have all the virtual and telehealth appointments? How do you manage all that? And how are you communicating these needs to the patients and confirming that they're having the option that is best for them? Are you looking at metrics? What is your third next available appointment? All of these things have to be considered and continuously monitored to make sure we're meeting the needs of a patient. So when we look at access and capacity, we really want to move from the historic approach of volumes and encounters. You'll hear a lot of us at MedAxian talk about patient panels. Dr. Wong talks a lot about that. She spoke about it at CVT and really we need our APPs to help support these high volume patient panels. So how do people use their APPs? This is our latest survey data. We are in the process of collecting this year's APP data, but as of last year, we see that 67% of our programs will use APPs for new patient appointments. We still see a significant amount of variability in the appointment time. So where are you following on this continuum? We see the majority at 30 minutes, but that's still over 40% of variability. So where is your practice falling? Is it consistent? When we look at patient types, you can see we're using APPs for a lot of different types. Namely, we look at those routine follow-ups for chronic disease management. So you can see over here, heart failure and EP appointments are highly utilized by APPs. We know they do a great job in managing those populations. A lot of post-hospital follow-ups, post-procedure checks. So how are you leveraging and how are you using your APPs? So we want to talk about strategies too, and you're going to hear strategies from all these programs today, but you want to make sure you're using a quick fix or band-aid fix of working. That doesn't work long-term. So you want to think of it from a clinical and an operational strategy, and then what is your culture? So clinical strategy is really in alignment with APP utilization to support those providers. Are you looking at, are you leveraging them for those special populations like we just talked about? Are you using them for follow-ups? Are they really supporting patient panels and not encounters? Operational strategies are heavy on scheduling. So making sure you have the right patient at the right time. Are you actively managing your schedule and engaging patients so we're limiting no-shows and cancellations? And then what does your team look like that is supporting that? It takes a lot of work and a lot of time to manage those schedules. And this really needs to be through a culture that is team-based, that empowers team members, that does not put in a hierarchy that all team members are heard and empowered because they all matter. And then ongoing monitoring of quality metrics and performance. This way you don't have surprises. You can course correct pretty immediately and regularly as needed. So when we talk about team-based care, we want to clarify what that means. So it's really a clinical strategy and a care delivery model. It's not a staffing model. It's not intended to be a band-aid fix for anything. So it's important that you know when we promote team-based care, especially using MAs, RNs, and non-clinical support staff, if you don't have the schedule access part down, adding team members is not going to help the situation. So you've got to make sure the access is in order before you start adding team members. One other thing I like to point out here is we have pretty good understanding of MA roles and RNs, but this other team member is only 5%. So what are we missing here? Are there opportunities to increase this clinic support to help support these patient panels? So thinking about solutions, we think about incentivizing productivity. That's not volumes. That is being productive based on quality, and that means routine data review, looking at quality metrics, and having those discussions so there are no surprises. We're engaging all of our care team members so everybody has open, transparent communication and understands where the issues are and helps to course correct. What does that performance management look like? Moving from a culture of no to a culture of yes, and are your roles consistent? So that was a very high-level overview of the things that are needed to have a successful access to patient scheduling. It's now my pleasure to introduce Dr. Wong, and she is going to share her story and part of their journey from Providence. Dr. Wong. Good morning, everyone. Thank you, Jenny, for the opportunity. Next slide. I know I was asked to present on patient access, but I'm talking, but I also told her, well, the patient access is actually not our strong suit. We're struggling with that, but the part two of the webinar series, provider scheduling, we have it down. So she invited me to share it briefly before going into the patient access discussion. So what we use is Momentum. It's a web-based app as well as a mobile app, and we have a scheduling team of staff of seven FTEs who work the schedule for our general cardiology heart fader interventional providers. And we ask everyone to turn in their vacation requests five months ahead, and the scheduling is done by the scheduling team next time with myself and another physician leader, and the scheduling team follows a scheduling rule book of who goes where, who has what subspecialty, what's the balance of call, and make the schedule. And this is published both in Momentum as well as in our EPIC four months ahead. And the Momentum schedule for each of the providers automatically syncs with our Outlook or personal calendar so that if there's any update, we can see it as well. And then twice a year, we share the tally of all the calls, city call, night call, daytime hospital, clinic, graphics days with everyone so that people can see that we're trying to even out the work burden. The holiday schedule is a rotation, and we do this multi-year so that we balance the burden, the work amongst all of us. With our sick call, we have a one-touch notification so if one of the general cardiologists is sick, all they need to do is text me, and then I send a note to a team's chat with who are the people who will change the schedule, notify the ED, change the patient template, and move patients. And we could do this starting at 5 a.m. each day. So I think in general, we have that done, but what we struggle with is a story that I want to share with everyone. This is a project called the new patient access optimization project that we undertook over the last 18 months or so. And we started out with a background that we have a long wait list for new patient referral. As you can see, the blue bar is the referral work queue, and red bar is the incoming daily referral, and the green bar was what we can work on the referral each day. And you can see that we have a significant backlog. And so we set our project goal to increase new patients seen by physicians by 25% in 2023, which is a very aggressive goal. And we understand historically when you see more new patients, it improves your downstream revenue, and we're able to shift the stable follow-up patients to our APPs, and then we can improve our panel size to match what Joe Sauer tells us we should do, which is 30% new patients and 1,700 patient panel size. However, the reality – oh, sorry. And next slide. Again, I'm kicked out. Did it change on the – is this the right slide? Okay, yeah. Oh, sorry. I thought I was kicked out of Zoom. So anyways, I – so if you want to study the MedExium survey and benchmark, the 2022 MedExium cardiovascular provider comp and production survey document gave us the information that over the last 10 years, the panel size has increased 25% for everyone, and we could do that because – next slide. Each practice is hiring more APPs so that across the board, we're seeing an average panel size of 1,700, and about one-third of that should be new patients. We can skip the next slide and then go to the next one. So these are the tactics that we put into place in order to improve new patient access for our group, which means moving – having a CICU service so that we can move heart failure doctors back to clinic and adding more virtual and in-person new patient slots to our physician schedule, and swapping out two follow-up slots for one new patient. So you can guess that we have 20-minute follow-up and 40-minute slots for new patients, and we also are squeezing out some of our in-basket time for more new patient slots. Next slide. So in – we slotted over close to 4,000 new slots in an attempt to add an extra 3,000 new patient slots for the year, but halfway into the year – so you can look at this dial, which we watch ourselves every month. We are only at 900 instead of – should be 1,500 into half of the year. What is happening is these new patient slots are still being used for follow-up visits because we've worked out – down significantly that work queue for new referrals. So you can say we're drying out the well for new patient referrals, and our clinic fill rate is very high, so it's not like we're not using these slots. But because we are seeing more new patients, our follow-up access became very poor, and our established patients are getting angry with us because they have to wait four months to see us. And it's affecting our health plan start rating and likely revenue in the future years. So this is very concerning for us. Next slide. Why do we think the potential causes are for us not achieving our goal despite putting these templated slots? One is for some reason we're seeing a reduction in external referral – external meaning outside of our Providence primary care. The second is we had unexpected – a couple of physicians retiring or moving out of the area, so we have to absorb their panel, which is quite large. So that's taking up some of these 40-minute slots. And the third major reason was that we were – we had a delay in being able to hire the clinic-only new APPs to absorb all the follow-up need that we anticipated having. Next slide. So – but I want to ask a deeper question, which is did we really set the right goals? And I want people to pay attention to this slide, which I analyzed the data for heart failure, general, and interventional, these three subspecialties together, looking at work RVU per physician FTE. And I put the work RVU into four categories – outpatient, inpatient, imaging, which means reads. These are all professional work RVUs and the procedural work RVU. So if you look at the dark blue line – so this is five years of data. 2023 is projected data. And you can see that there's a significant rise in outpatient work RVU. The second blue line, the lighter blue line, is the inpatient work RVU. It's pretty static. During the pandemic years, we were busier in the hospital. And then the green line, the top line, is the imaging, the ancillary. The reads is gradually going down, despite the fact that we're seeing more outpatients. Okay, this is a very concerning trend. And then lastly, the gray line is the procedural work RVU has seen a significant decrease. So what is this telling us? It's telling us that we are becoming more like primary care. We're managing chronic disease. So meaning increasing outpatient volume did not necessarily translate into downstream revenue, which may be good for the population because we're better able to manage the patient medically, but it's not good for our industry because think ahead, who is going to be paying cardiologists and cardiology APPs at a higher rate than primary care. If all we're doing is cognitive patient, chronic disease management. If you look at the graph on the right, the only difference is that I overlaid this dotted red line, which is the panel size for our physicians. And you can see indeed over the last five years, the panel size has increased and that correlates with the outpatient work RVU increase. But again, that is going in the wrong direction, the opposite direction to our downstream revenue, the imaging work RVU and the procedural RVU. Of course, anesthesia shortage is a major determinant, but we have to look carefully. So my learning from this is not all new patients are the same and not all patient panels are the same. There are new referrals that are higher complexity, more acute who will generate more downstream revenue. And the patient panel is the same. If we're managing active cardiovascular disease patients, that will correlate with higher downstream revenue than stable chronic patients. So it comes to the second point, which is we need to improve referral quality. And that's not by setting boundaries or barriers for referring doctors, but rather that we as cardiovascular team needs to better triage, better manage and shift the low complexity patients to other forms of care. And lastly, optimize patient panel size. So use physicians for the more complex active patients shift, chronic disease management to APPs and other caregivers and return stable patients to PCPs. That's my portion. Thank you. Thank you for sharing that. And thank you. You know, like so many stories, there's lessons learned and this is not an easy fix. So it is, it does take sometimes some work to figure out what works well and what does not work well. And the things that don't work well are great education points for all of us to help us be successful. So we're going to move on now to Dr. Wants. Dr. Wants, take it away. Thank you, Jenny. And thank you Medi-Xium for the invitation. My screen's been flickering and I lost the slides a couple of times. So I'm not sure if that's something everybody experienced or just me. So bear with me. So I'm going to talk today about optimizing patient access and with me, and she'll make some comments a little later is Chris Bopp, my invaluable dyad director for cardiovascular service line. And we're a group of 50 cardiologists just to contextualize this for a moment. Next slide. So I'm going to talk largely about three things. And, and, you know, Dr. Wang's presentation was I think, fantastic and highlights. I think many of the issues that a lot of us are facing, but I'm going to focus here on some of the programs we put in place strategies for access. And one is our, we call it our EACCC, our early access cardiovascular clinic. I'm going to talk about HYCU virtual option, which we've piloted fairly successfully, especially in our EP division. And then our way of evaluating, we serve about 1.5 million people in a, in a large catchment area in West Michigan and how we're looking at our services in the region. Next slide. So early access, the EACC, you know, what is this and what do we mean by this? So this, we opened this three years ago with the intent of providing quick access for patients within 72 hours of a referral to cardiology. So within 72 hours, these patients are going to be seen. And these are specific population we put in here. They're patients that are new or pre-op referrals with surgery planned within a week. They're new patients who have abnormal test results that require more facilitated review and consultation and then new referrals with an onset of new symptoms ranging from palpitations and syncope to dyspnea and chest discomfort. So that's the population we're looking for. And again, we don't start putting, filling these spots, which we always completely fill until 72 hours before the visit. Visit types not included will are subspecialty consults. So we don't put a complex EP consult, for example, to the EACC. We don't see established patients there. So this is a way to really build up new patients. And we don't include second opinions just because those are often very complex and take a great deal of time. Next slide. So we do this five afternoons a week across multiple locations, eight slots per half day. Again, slots opened 72 hours beforehand. So we're really getting more urgent consults. Seen primarily by interventional cardiologists, we've kind of varied which members, which subspecialties we deploy in the EACC. And so many of these are abnormal stress tests or new unstable angina that interventional cardiologists are doing a lot of this. And then the referrals are screened by a triage team and a clerical team to get the right patient in the right spot to be seen in the EACC. Next slide. So we have an EPIC build for this. So referring providers can refer patients via EPIC to the EACC, which you can see the red arrow pointing to that. A new service button was created for this within our cardiovascular medicine division EPIC referral. And if a patient does not meet criteria, they're directed to select another option. And again, these criteria, new patient with abnormal testing, new patient with pre-op within one week, and a new symptomatic patient. Next slide. So what are some of the results? On the far left, you'll see cardiology or imaging studies ordered the same day in 40% of patients. That's been pretty consistent since we launched this program. And you can see the volume numbers there. Procedure ordered the same day as EACC in about 30% of patients. And if you look at cath lab performed on or after EACC appointment, that's in 20 to 30% of these patients. So I'll call it yield, but these are patients that are needing care, needing testing. So relatively high yield, getting a large volume of patients through in a fairly short time. Next slide. So that's EACC. We actually have continued to expand this to other locations. Our primary care providers love this, as do our patients. The next thing I'm going to talk about briefly is HYCU virtual visits. So what is this? It's using Epic, HYCU, or Canto in the Epic app that providers, clinicians can access from their smartphone. It provides authorized clinical users access to the medical record with clinic schedules, hospital patient lists, health summaries, test results, and notes. This app does that. HYCU can conduct video visits via these apps, and this is what we're using. And it's provided an option to fit patients into an already busy office or procedure day. You know, folks that were normally making a phone call, it can sometimes be a 10 minute, 15 minute process and going through something with a patient can be done on HYCU and documentation charges are the same as a telemedicine visit. So a very effective way to communicate with our patients. Next slide. And have those visits all billable. So downstream effects of increasing referral volumes and reduced patient access. We know increasing number of requests for patients to be added in a busy clinical day is difficult, and increased volume of remotely managed patients, you know, through an inbox consult is also not easy. So we hope to, you know, we address patient calls to the office, MyChart messages, telephone calls to patients during after working hours. You know, many of this can be approached this way. Next slide. So the access clinic, seems like these got a little out of order. The downstream effect of referral volumes and reduced patient access are increased number of patients to be added to a busy clinic day and increased volume of remotely managed patients that as these inbox consults, you know, we're avoiding some of this. Next slide. So here's an example of a case and our EP docs have really gotten their arms around this more than any other group. So 65 year old physician, history of symptomatic atrial fib, an ablation, spring of 2022 sends a MyChart message in June with increasing palpitation, shortness of breath in the setting of PVCs, scheduled for an office visit, 823, monitor an electrocardiogram, echocardiogram prior to the visit, patient misses the appointment. So wrong day in my calendar, doesn't show up. Next slide. So the patient calls to apologize, request the visit to be rescheduled because he's continuing to have symptoms. What would you do next? Reschedule the next available return visit, which sadly is sometimes months off. Reschedule with an APP, which in our practice is easier. We have about 25 APPs in the group. Call the patient after hours to discuss, you know, again, that can sometimes be, you know, not a short conversation, 15, 20 minutes sometimes, or schedule a HYCU virtual visit in between procedures, which is what our EP docs are regularly doing now. Fully billable. And just to comment, I don't know that this, remember that this was in the slide, a range of time is given rather than a specific time. So when we schedule this, it can be scheduled like between 11 and one. So patient knows they're going to get a call. It'd be virtual in a timeframe rather specific time, which allows us a lot of flexibility as to when we schedule these. Next slide. So HYCU Doximity virtual visit looks like this. Here's the HYCU app. The calls go through Doximity. You can then click third iPhone picture on the phone number there. And then it goes through to the patient. Again, it can be video, audio, or both. Pretty simple again, using Epic HYCU and Doximity and it's HIPAA compliant. Next slide. So the visit options become, if the patient has a smartphone, you basically can schedule this fully in Doximity. Patient doesn't have a smartphone, but has MyChart access in Epic. We schedule an Epic HYCU traditional telemedicine visit, or patient doesn't have a smartphone or MyChart, then we do an audio only visit. Those become the virtual options. Next slide. So the opportunities in virtual care, I think are many hospital emergency visits, follow-up test results, medication titration, pre-procedure discussion, or patient specific concern. These are kind of the five categories we see that we're using this platform for. Next slide. And then finally, I'm going to talk a little bit. So I talked about early access clinic, alternative strategies using HYCU to see patients. That's been very effective. And then we're now looking at our regional care. And we're trying to evaluate, we're in 13 locations around West Michigan. So we're evaluating locations that are covered by our zip code, panel size, and population density in each area. And Chris has done a lot of this work for us, using market share data to understand our best locations. And then we've developed dashboards to track this data, to strategically understand the value and the impact of being in the region and our providers spending windshield time. We've always liked to do things as close to home as possible, but this has been our strategy to really review all of what's occurred over time, iteratively and snapshot in time. Now we're seeing, looking at each region and see its value and how well it's working. Next slide. So we have a dashboard referrals by county. This is the state of Michigan. We're the obvious place, 43,000 in the bottom left. And we see people from all over Michigan, but you can see the counties right around us where the greatest number of patients go. And as you get further away, we're a quaternary care center. We do see patients from all over the state. Next slide. And then panel size by region. So we're now kind of coupling what we do in the region with our panel size at these, I think it's 13 in total, maybe not quite that many listed here, where we're providing services. So this is one of our next steps in our approach to So this is one of our next steps as we try to look both at provider scheduling to the theme on this webinar, our provider scheduling and patient access, which has to be important. I like the language we've seen with Medi-Axiom in some places of a yes culture, and we just want to be as efficient as possible as we do that. Next slide. I think that's my last slide. And Chris, I don't know if we want to save Chris for questions. Jenny, is that move right into the next talk? Is that what you'd like? Yeah, Chris, if Chris had anything to add, she's welcome to come on, or we can. You want to come on for a moment, Chris, and comment on EACC, HYCU? Yep. I did answer a few questions in the chat that were posed. So hopefully everybody saw that. HYCU, I guess, is something that I will tell you has been a game changer for our EP physicians in particular, because sometimes their lab is done earlier, or they can kind of fit that in. HYCU works really just by sending that patient a link. So it really just is slick and easy. And that's been, to David's point, where we would often do those uncharged, unbilled, but even undocumented in Epic. So this allowed us to continue their care flow. So there was a lot of excitement about HYCU. Early Access Clinic has been also a game changer for us. So when we look at metrics, we generally can get patients in within 14 days by doing the Early Access Clinic. And we don't release those slots until 72 hours before, and that way nobody can take them and use them for something else. So both have been great game changers for us. Great. Thank you guys so much. I love several of the points you said, and I think we'll probably circle back to it, especially about virtual visits and giving them a window as opposed to a certain time. I think that would be a big game changer, especially for physicians and how much is going on and take some of the stress off of kind of that, because you know you have all the technical challenges and other things. So appreciate your insight. And we are going to move on now, but we'll see you guys at the end of the session and have some questions for you. So it's my pleasure now to introduce Alan and Danielle from Lehigh Valley Heart and Vascular Institute. Alan and Danielle, I'll let you take it away. Jenny, thank you very much, and thank you to everyone who's participating. And thank you for MedAxium for putting this together quickly. Our experience with this was from some questions posted on the listserv. We answered for some people, and actually one of them was Dr. Wang about some of the new roles we've added to improve access and improve operations. And that's what we're going to focus on today a lot. And we'll acknowledge there's many, many different levers to pull for access, and access has been the biggest charge to us from our CEO. New patient access, new patient access. And in the course of today, we're going to share what we've done with a new way to get patients in for service, a new role. And if there's time, we can maybe refer to some other interesting things that we have done to improve access, especially for new patients. So far this year, I'm happy to say without sacrificing our return visits, which had happened in the prior year. Right now, we're keeping those where they should be. Danielle, please take us through the description of what we've done so far, and thank you. Sure. Thank you so much, everyone, again. And thanks, Alan, for that introduction. We'll go to the next slide. As Alan alluded to, we wanted to focus on some of the new roles that we've developed as we recognized our team needed to evolve to meet a number of needs. I'm sure many of you were also challenged during the pandemic, not just shifting to the virtual care and staffing, but also just having the team available. And so as we looked at our care team, we recognized segments of work could be done outside of the walls of the physician practice, as we've known, but we've adapted to really meet that need. And so around the patient, aside from our clinicians, our physicians and APCs, as previously described earlier in this talk, we really considered the role of the medical assistant, the RN in the office, and what was something that they were doing day in, day out, that might not need to sit with them, again, physically in the office, to really empower them to spend time with the patient during rooming activities, triage activities, and the like. And through some of that discussion, along with our administrative roles, came two different types of physicians within our entire physician group. And those were the care navigation partner, which is a clinically focused role to really elevate one of our, you know, our RNs in a different manner. So instead of managing just the incoming influx of information, really supporting the navigation of patients through whether it be an episode of care or their long-term experiences within the practice. The role I'm going to spend some more time on today describing is the Care Coordination Partner. This is really our key team members that are focused on supporting our access initiatives and again, supporting our patients through their experience in our practices. I'll acknowledge those two roles I just mentioned, the Care Navigation Partner and Care Coordination Partner were designed to be hybrid in essence, not necessarily needing to sit within the practice that they were supporting, the face-to-face interactions, but able to really make sure that we could take care of those functions in an appropriate manner, recognizing that we had to be a little bit more strategic in how we filled those roles. If we go to the next slide, this will show a visual of what we consider our new patient experience to be. I think as alluded to earlier, referrals come in a number of different ways and we experienced a significant increase in our incoming referrals to cardiology in March of 2021 and had to really think of how we can meet the patient demand in terms of access and that lead time. Starting at the top left in that entry into the continuum, we recognize that we're receiving referrals in lots of ways. We also allow for scheduling to take place within our network in a number of different methods. Whether that is at checkout in primary care and primary care registrars is supporting that appointment scheduling and cardiology just by directly scheduling into the appointment. We have that occurring in our emergency department at the time of discharge to again make sure that we have that follow-through of referrals or even the patient self-scheduling themselves through some of our guided scheduling pathways. However that scheduling occurs, our care continuum partner will engage. Most frequently, it is still calling in via phone call that they would receive a patient looking to schedule a new patient appointment and we really wanted to make sure that we could provide not just the access but an experience that was able to put the patient at ease, give them everything they needed and really tee them up in the best means possible. I'll say at our best, our goal is to have the patient seen within 14 days of referral and appointment and that we know that that doesn't happen all the time. When it doesn't, we are able to offer some additional mechanisms for the patient to connect with us virtually via some of the similar video visits and phone visits as mentioned earlier in this presentation. In doing so, we can at least ensure when the patient shows up that we have the information needed, that they may have been able to have testing take place before that point in time and really have a more fulfilling visit. The third item listed here is a digital welcome package. Again, trying to acknowledge that we're in this digital world, how can we empower our patients to have information available knowing what they need to know as a new patient to our practice, how to get there, where to park, all those logistics that make people feel a little more at ease and then can make it much more streamlined on the day of the visit knowing that that's all available. The other big component here was helping support patients with myLVHN, which is our MyChart or patient portal equivalent, and making sure they recognize all the functionality that is available as a new patient. So, from the onset, being able to engage a little bit differently, feel special and connect with the cardiology practice. So, the last item indicated here, the welcome video visit, this is something we designed for those patients that we knew we were not able to see within two weeks to offer the opportunity to connect via that video visit or phone visit where we have a nurse practitioner that's able to do some intake for patients and evaluate if there is additional testing that needs to be ordered ahead of time, in which case we would take care of that, help get that scheduled. And then also, you know, ensure any medical records or questions that the patient might have that they're not sitting at home anxious, you know, for their upcoming appointment, but they know that they can still contact us as well. If we go to the next slide, I believe this details just a few more comments about the Care Continuum Partner, recognizing this is a little bit more of a unique role. So, these are both either administrative or clinical, typically a medical assistant who's taken on a little bit more of an administrative flair that supports that new patient scheduling and experience. A lot of the other items that take place, you know, is really in an effort to make the face-to-face visit as efficient as possible, and yet also ensuring that there's the time able to get the patient at the point of scheduling as well. I mentioned that digital welcome package. Again, an emphasis of ours, I'll say access is number one, but certainly making sure patients are engaged in their own care is number two, and the portals and mechanisms to allow for that to happen. And then the scheduling of those visits with the advanced practice clinicians is really another key duty. So, those items right now have been prioritized as in their roles. The next slide, then. This is an example of some of their standard work, and so, you know, scripting certainly helps support this, but we also recognize the opportunity to go off script sometimes and to hear and have that conversation with the patient to make the connection. We empower them with a number of tools that are, you know, updated in terms of standard work, both within the EMR, within your insurance grid, things of that nature. So, really being the experts of where the patient, you know, what's needed for the patient up front, and who's best suited to see the patient as well. Go to the next slide. So, and Ellen, please feel free to chime in on this next one. So, I talked a little bit about where we've been, and I think at this point in time, we see the opportunity for this role to continue to evolve into a more, a smaller care team-focused, specialty-focused type position, really being that administrative point of contact with a smaller care team. We're starting to develop this with groups of about four or five physicians and a number of advanced practice clinicians as well, recognizing that we do have some geographic factors that come into play, and then obviously some specialty factors as well, and so trying to maximize, you know, what those most efficient pathways might be. Aside from the other items in that new patient pathway I discussed, you know, we really want to make sure that these colleagues feel empowered to be those care coordination experts, to identify the opportunities and the gaps in the schedule, and, you know, maybe Mrs. Jones would prefer to come in on this other day because I know she likes, you know, whatever it might be, right? But understanding the nuances in the schedule, finding the opportunities to either pull up patients, utilize wait lists, or also just see if there's a chance to maybe even have overbooks appropriately, knowing some of the responsiveness of no-shows and things of that nature too. So, we've done a lot to empower the colleagues with tools, and I think as we continue to organize them in these smaller subsets, it will really allow them to feel even more engaged in their day-to-day. Alan, anything else you mentioned here? No, I think you've done it very well. Getting the care team together is also part of a project we're working on, and we're evaluating both homegrown guided scheduling interviews to let patients self-schedule more or let our staff use them. In addition, we're looking at some third-party ways for that, but again, taking this care team idea, the hope is that as we roll this out, each of the care continuum partners as part of a care team will be the front face of that care team, and sometimes maybe it'll be two, depending on how busy they are per team, so that they can take care of all these things and make sure that what everyone has said in all of their presentations, the right patient with the right provider at the right time, and make sure that we have that engagement. Also, as it evolves, we're also hoping to make them almost like the first point of contact for follow-ups, like a customer service representative, if you need anything on the person you talk to. Really, not only for the patient, but also for the staff to have that feeling that they are connecting with patients and that they are their partners in care. Thank you. Oh, go ahead. Go ahead. Thank you. I was also going to just say, when we look at what a lot of this has done, and again, I said there's multiple levers that we do. One of the other things is we were given a charge by our CEO last fall because of the importance of new patients in terms of market share, as well as the continued consumer loyalty that we're developing. We were given a charge to beat our new patient volumes that were already established in our practice and in our budget by 100 patients per week. We did it on a rate of over 480 to 500 new patients incremental, above what we were originally projecting for seven out of the eight months since the charge, which resulted in a total of 24,613 new patients, 12% over the prior year. The biggest thing we did is we created Saturday new patient hours. Surprisingly, the doctors loved it. We knew the patients would love it. The doctors really loved it. That has been really, really successful as a differentiator for us. Thank you. We'll round out, I think, one last slide just describing some of the outcomes that we've experienced in this new patient partnership model. We've had over 1,700 patients who have accepted that video visit and then followed through with their face-to-face visit as well. As you can imagine, we do see both the improvement in lead times, being able to receive the testing ahead of time, a decrease in those no-shows when they engage in the video visit ahead of time. They feel connected to the network, even if they aren't able to physically come for some time. Then during that face-to-face visit, we had not all, but a number of physicians feeling comfortable reducing the time of that visit slot because there was so much work up and down ahead of time as well. We continue to monitor the patient satisfaction, setting those expectations. It's really been a key differentiator in how we provide care at this point in time. Thank you all for your time and look forward to any questions. That's great. Thank you for sharing. I had a quick question about what kind of person are you looking for to fill that role? What's the ideal background personality that you look for when you're recruiting for this position? Given the scheduling skills required and registration skills required, this is typically a stepping stone, a promotional role from our registration team. I think as much as we would love for it to be someone who is all about customer service and only customer service, we also recognize there's a steep learning curve of the EMR and our scheduling systems. Given that, we've been able to really promote within and see this as an alternative role, a little bit more of a ladder. That's wonderful. I think that's great because I feel like those opportunities for those roles are pretty limited. That's a great engagement strategy. I'm sure that is probably helping with turnover too. I think that's a great strategy. Well, wonderful. Thank you so much. I know we've had several questions that have been answered. I'm going to ask all the panelists to come back on camera. If you do have any questions, please enter them into the Q&A box down at the bottom. I'm going to look back because I know we had a lot of really good questions. Just see what we had for maybe further discussion. Megan, I know you asked a question about how advanced heart failure physicians got the direction to give up ICU work for clinic. Dr. Wang, you want to talk a little bit about that? Yeah. It was mostly the... We put in CICU service 24-7. Before that, our heart failure transplant docs were taking in-house night calls, which limited their post-call availability to work or to do clinic. With this, during the daytime, they're still rounding and taking care of the heart failure transplant patients. Then at night, their night call is not in-house. Then post-call, they can be working in clinic. Okay, great. It was a little bit of a trade-off there. I'm sure anybody would be happy with less call burden. That's great. Let's see what else we have here. For our Corwell team, how did you teach the referring providers about your EACC to communicate the use and what the appropriate patients are to send there? Chris, why don't you take that one? Yeah. Basically, we got invited to their management council or their section meetings, gave multiple presentations, as well as put it in our EPIC newsletter to basically say this was rolling out. We did a massive education before we went live and then did some reaffirmation afterwards. We also created the triage team. Then they would reach out to the referring provider to help educate on how to properly do it, as well as we use the liaisons too. The other piece to our referrals is we review all the referrals outside of anything coming specifically to EACC. If we have other patients that are referred just as a new patient without being referred to EACC, we review those as well, and we place them in the EACC. Most of the time, those patients are shocked that we're getting them in. It's kind of a dual role. It's also referral, but as well as us triaging and looking for patients so they don't slip through the cracks. That brings me to another question. I think that's great you have somebody reviewing that. We often hear about inappropriate referrals and managing those. I think people have a hesitancy to say, well, this isn't the appropriate patient, even though it's taking spots on their schedules that another patient would need. This is just open for everybody. How do you manage that? Is there communication back to that referring provider with some feedback or a different plan? What's each of your strategies around that? I'll respond to that first from our perspective. We do go back and try to re-educate because we want them to refer the correct way. We will go back, especially if it's a theme for an individual that we kind of see the same inappropriate referrals. Our triage nurses actually are the ones that make that contact with the ordering provider and just kind of review what our process is and our steps. And usually they're happy to hear from us because they want to refer correctly. So that's what we do. A great example of that. I mean, great response and great question, Jenny. That's a tough issue to crack. I mean, one of the major places we've had great success is with our GI doctors sending everybody with a cardiac diagnosis for clearance or to guide an interruption of anticoagulation or antiplatelet therapy, none of whom need to be seen. So that's taken many visits with that group because they were just regularly sending these patients and clogging up either appointments or inboxes with these questions. That's pretty standard work in terms of interruption and so on. So a lot of education though. It's hard to change those habits sometimes. The next group we need to work on is the ophthalmologists and plastic surgeons doing eyelids or whatever that want a cardiology clearance before they do a cataract or eyelid surgery. Definitely. No, thank you for that. Anybody else have any feedback or comments? Could I, Jenny, could I ask a question to Dr. Walms and Chris? So how do you got, so let's say there's a, the case that you presented, how did that incoming call or message turn into a scheduled HYCU appointment and who did you schedule to? Yeah, so generally our nurses would have been the recipient of that message. So they would work in turn with their assigned EP provider in that case. Basically, they tell them the story. They tee it up for them. That provider then looks at it and then says, yeah, this would be a great HYCU visit. At that point, they work with the RN and we have an assigned MA person or an MA HYCU person every day. And then they're the conduit to the timeframe around the physician's direction and schedule. So nurse to doc, doc back to nurse, and then we have a support structure with our rooming team who basically all day just do HYCU all day. And they set up those visits and coordinate the time. So the physician who has these things being scheduled onto their schedule, are these set blocks or are they doing their daytime things and it's just, it shows up on their, on their schedule? Exactly. They do, but we give the patient a timeframe. So it's kind of like when you're going to get furniture delivered, right? You give them a timeframe of 2 to 4 PM, be ready to see this text from the physician. And then as soon as they do, please click on and we'll be ready to hold your visit. Been very well received by our patients. And to be clear, it's visible to the provider. And these are some, some docs are still not doing this. We're still in a rollout phase with this, but all of our EP docs and one, especially doing a lot of this. Yeah. So it's really in their control, right? They, they get to control the timeframe. So it doesn't add stress to them if they are able to kind of guide when they'd like it. And are your providers, physicians, protection incentivized? We, we are a seller. We're salaried based on blended survey data with incentive compensation based upon quality metrics, citizenship, and production. Very good. Thank you guys so much. I think we are going to wrap up. We appreciate everyone who was able to join today and a special thanks to all of the panelists and your time and dedication to educating us today. As you know, this is not an easy thing to tackle, but I love the innovation. I love learning lessons with each of you. We do have part two, where we will, my coworker, Anna, and her panel of guests will be talking about physician schedules that are part of the We will have this recorded in the questions as well. I did also want to point you guys, we do have some white papers that also may help as you're trying to tackle this, thinking about access, or we also have utilizing APP. So want to make sure you have that reference there. And if you have any questions or need help finding either of those, please don't hesitate to reach out to me via email. Also looking forward to seeing many of you at our upcoming CVT in Austin in October. Again, thank you all for your time. Have a great day.

patient access

scheduling

cardiovascular healthcare

care navigation partners

care coordination partners

appointment scheduling

patient triaging

care coordination

virtual visits

referring providers