Improved Integration: Core to 2023 Successes

By Matt Phillion

Now that 2022 has drawn to a close, it’s a good time to take stock and figure out what is on the horizon for 2023. Supply chain pressures, workforce shortages, and more have presented the healthcare industry with many challenges to overcome, and other financial and labor-related pressures continue to mount.

Rich Miller, chief innovation officer with QGenda, has targeted a number of challenges he predicts will be top of mind for healthcare organizations everywhere in the coming year.

“The last six months have been a transformative period for healthcare,” says Miller. But transformation also opens the door to new challenges. Take, for example, the continued consolidation of health systems. These systems merge but often fail to integrate successfully, and the cost of that lack of integration is coming home to roost. Miller describes a conversation with a colleague whose organization recently underwent a massive merger.

“They found that they had trouble getting the workforces to work together—there was territorial behavior, chain of command issues. They still had two departments for everything,” says Miller. “There were struggles with managing schedules and providers, and it hit me like a bomb: Knowing where our providers are and having an accounting of that is the integration tool.”

Between mergers and bringing private practices under a larger umbrella, “merger mania” continues, but it’s not a young process anymore—so it’s time to show a level of maturity in establishing those mergers.

“When I think about 2023, we’re in some ways at the end of a big push or a mature place for health systems to grow,” says Miller. “We’ve been merging for well over a decade, trying to bring together and build bigger-scale systems to be more efficient.” Now, though, the industry is recognizing that the mergers have not worked well. Prices have gone up, patient access has gotten worse, and even quality of care has slumped.

“Clearly there’s stuff that everyone in healthcare recognizes as a serious problem, and I think there’s a huge backlog of integration work—not technically, but the integration of people who are going to deliver care to patients,” says Miller.

A new view on integration

Healthcare has been working on integration for a long time, Miller says, but it’s been focused on the electronic health record (EHR) and the patient-centric impact.

“Before implementing one of the big enterprise health record systems, a hospital might have 20 EHRs, one for each department, which meant that the patient was constantly needing to re-register themselves,” he says. “The big focus over the past 10 or 12 years has been on creating beautifully integrated workflows to manage patients, and we’ve done that. When a patient shows up, the hospital knows who you are, there are fewer questions, and there’s better continuity.”

But the provider side hasn’t seen the same level of integration. “Providers are still in this hodgepodge of best-of-breed systems. The provider system landscape is solidly 10 years behind what EHR has been developed into today,” says Miller.

Miller sees the EHR as a funnel. “It takes a patient with symptoms of a ‘stomachache’ from their PCP, to a GI specialist, to an oncologist, to get the patient through to the point where the curative moment happens,” he says. “There needs to be an equivalent system for managing providers.”

Medicine has always been about connecting a patient with a problem to the appropriate care, Miller says. The industry needs a system that helps align the patient with the right provider at the right time and place. Current scheduling systems aren’t tailored to the needs of healthcare, he notes.

“It just doesn’t work well, and what we’re experiencing right now is a crisis of care. Providers are super burned out,” says Miller. “I think it’s a result of provider management not working well. It’s not always a rational work environment.”

Three fixes

Miller offers three fixes to improve integration and thereby alleviate the cost of the provider crisis we’re facing.

First: to make these integrations work, an enterprise must leverage autonomy for efficiency and performance. “We need to have the ability to be big for the things that work well at scale. For example, you want to have a view of on-call and referrals that is networkwide,” says Miller.

This means the ability to immediately find the right person for the situation. If the ED needs a consult from a vascular surgeon, for example, the enterprise needs to be able to find them and manage caregivers across the organization. It also needs to able to move people around easily in an age where mergers and integration mean multiple facilities share assets and talent.

“If we’re running in a siloed way, we’re not going to be able to move people around to respond to those care needs,” says Miller.

We need high-performance work environments and clinical centers of excellence where patients are getting great care with great efficiency; the only way that becomes possible is by leveraging autonomy, he says.

“A lot of what we’re learning is ‘at what level we should manage this?’ ” says Miller. “Build an enterprise culture that also keeps in mind you have to fiercely protect autonomy, innovation, and performance.”

Part two to improving integration is consolidation of systems. “We’ve got smatterings of systems all over the place, and a lot of paper in the management of our provider population,” says Miller. “And then you’ve got affiliates who are working inside and outside, but you need this to be seamless.”

To Miller, organizations must specifically concentrate on consolidating IT systems. He notes that IT’s long-time focus on the EHR has been successful, but “on the provider side, it’s a different problem.” Those systems are not healthcare specific and often don’t have credentialing or nurse scheduling built in. There’s an opportunity in this space that organizations can’t simply address by gluing systems together. “If you don’t have something that is integrated as a whole and designed to work together, you don’t get the big workflows,” says Miller.

As an example, take credentialing and scheduling, which traditionally have been managed separately. Essentially, credentialing is the authority to deploy a provider, and scheduling is the mechanism to deploy that provider. The system needs to be like a conductor, tracking when providers work, what their clinical responsibilities are, and where they have clinical hours.

“Putting the authority and deployment mechanism in a single space means if you hire a new person, you can start planning their clinical schedules and patient schedules that day” knowing when they’ll be onboarded, Miller says. “Conversely, if something happens where their credentials are revoked, or if something is wrong with their payer enrollment and they can’t bill for services, you can pull the provider right away. If those workflows are tied together, the moment something is wrong with credentialing, you can update the schedule.”

The third component: supporting providers. During the pandemic, “we were rescued by the provider population,” says Miller. “They were fighting for us and really risking their lives.” But over the course of COVID-19, there has been an increase in poor treatment of providers by the public, so much so that hospitals are shutting patients out for abusing providers.

“The part we have to play on the provider operations side is that first, we want providers to feel like they work in a great environment, that they’re effective and not distracted by administrative stuff,” says Miller. “Second, providers need great tools for managing their role, to have command and control over how they work. Let’s empower those providers and help them run really well.”

In concert with these three items, organizations need to help make the provider lifestyle sustainable. If an item such as a scheduled appointment needs to be shifted around, having a system in place to find the right person credentialed to cover a shift can help manage not only that individual interaction, but also scheduling overall: vacation, consultation, on-call, and clinical schedules.

“What could be more important than having an abundance of quality providers engaged and excited to do this work?” says Miller. Of course, getting there will require thoughtful implementation and planning. “We’re not going to be able to do this by ladling more money over the fence. There’s big stuff in the future for provider management.”

Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at matthew.phillion@gmail.com.