The document discusses key challenges and strategic solutions in ambulatory healthcare settings, focusing on workforce management, integration, patient access, and value-based care. Increased physician burnout, workforce shortages, and the need for efficient operational practices are highlighted, along with the importance of data-driven decision-making. Solutions include optimizing workflows, enhancing leadership engagement, and leveraging advanced analytics to improve patient access and meet payer requirements.

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Addressing Key Challenges in Ambulatory Settings
Strategic Solutions for Workforce, Integration, Access, Value-Based Care, and MSO Services

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Today's Speakers
Holly Burke
SVP of Practice Management
and Physician Solutions
Sarah Roberts
SVP of Ambulatory Practice
Management
Travis Simar
VP of Population Health and
Payer Services

3. Agenda
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1. Optimizing Physician Workflow and Autonomy
2. Navigating the Impact of Healthcare Integration
3. Balancing Patient Access with Available Resources
4. Best Approaches to Align with Payor Requirements in
Value-Based Care
5. Enhancing Operational Efficiency for Managed Service
Organizations (MSOs)

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Optimizing Physician
Workflow and
Autonomy

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Poll Question #1
Within your organization you are utilizing data to manage
your ambulatory operations in the following areas:
a) Physician Productivity
b) Template management
c) Referral Leakage
d) Third Next Available
e) Encounter Count and Unique Patient Counts
f) Support Staff Labor Management
g) Revenue Cycle - Billing/Coding Variations

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"The impact of COVID, the aging
population, and provider shortages have
created a burning platform for health systems
to address the need to adjust their relationship
with physicians."
Workforce Management

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Workforce Management
Burnout Cost Burden Shortages
Physician burnout has
increased from 45.5% to
62.8% in ten years.
20% of doctors don’t
anticipate being at their
current practice in 2
years.
The cost for a health
system to replace a
doctor is 2-3x a MD’s
total compensation.
Aging Population
By 2034, it is predicted
that the United States will
have a shortage of up to
48,000 primary care
physicians and 76,000
specialty physicians.
By 2030, every baby
boomer will be 65 or older.
This means that 20% of
the U.S. population and
33% of the MD workforce
will be retired.

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Medical Education and Regulation
Impacts the pipeline of new healthcare
professionals.
Health Plan Challenges
Struggling to build high-value provider
networks due to workforce shortages,
limiting patient choice and access.
Hospital Operations
Challenges in maintaining adequate
staffing, meeting quality metrics, and
ensuring timely patient access to care.
The Impact of the Healthcare
Workforce Shortage
Public Health Crisis
The scarcity of this essential resource
underscores the gravity of the situation.
Eroded Public Trust
The shortage of healthcare
workers undermines the ability to
deliver effective care.
Barriers to Care
Efforts to remove barriers to care are
hampered by the workforce shortage.

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Solutions to Workforce Management
Template Management
• Implement efficient scheduling
systems
• Use data-driven insights
• Streamline appointment
templates
Top-of-License Support Staff
• Optimize workflows to promote
top-of-licensure skills
• Delegate administrative duties
• Implement clear role definitions
and responsibilities
Physician Governance
• Foster a sense of ownership and
engagement among physicians
• Establish governance structures
• Encourage active participation

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Solutions to Workforce Management
Physician Leadership
• Provide leadership roles
through committees
• Encourage participation in
practice management
• Cultivate a sense of ownership
in clinic operations
Aligned Compensation Plans
• Design compensation plans that
align with practice goals
• Incentivize contributions toward
strategic objectives
• Promote performance and
alignment among clinicians
Continuous Learning
• Invest in ongoing education and
training programs
• Stay informed of industry trends
• Expand contributions to practice
through continuous professional
development.

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Navigating the Impact of
Healthcare Integration

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Poll Question #2
Within your organization the following leaders are
responsible for governing decision making
for the ambulatory operations?
a) CEO/ CAO
b) COO
c) CMO/ Medical Director
d) Physician Leaders
e) Director of the Clinics
f) Manager of the Clinics

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The Rise of Physician Integration with
Hospitals and Corporations
Nearly 75% of physicians are employed by a
hospital or corporate entity since COVID.
Since COVID, more than half of physician practices are
not owned by hospitals or corporate entities.

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The Impact of Integration
Economies of Scale
Reduces costs by consolidating
overhead, IT, and admin functions.
Negotiating Power
Larger integrated systems gain
leverage in negotiations with
suppliers and payers.
Work/Life Balance
Streamlines processes to reduce
administrative burdens on providers,
supporting better work-life balance.
Referral Capture
Improves ability to keep patient
referrals in-network, increasing
continuity of care and revenue
opportunities.
Comprehensive
Continuum of Care
Supports coordinated, full-
spectrum care, enhancing patient
outcomes through integrated
services.
Referral Capture – Stark Laws
Potential compliance challenges with referral
practices under Stark Law regulations.
Anti-Kickback Statutes
Integration increases the risk of non-
compliance with anti-kickback rules, requiring
careful management of agreements.
Productivity
Balancing increased network size while
maintaining high productivity and provider
satisfaction.
Benefits Risks

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Integration Solutions
Care Across the Continuum
TAVR Tools
Physician Productivity
PopAnalyzer
Panel Management

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Balancing Patient
Access with Available
Resources

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Poll Question #3
Which data-driven solution do you believe would have the most
immediate impact on improving access in your organization?
a) Implementing advanced referral analytics
b) Using scheduling algorithms
c) Creating a real-time resource allocation dashboard

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The Access Challenge in Ambulatory Settings
Supply vs. Demand Mismatch
Long appointment wait times,
underutilized resources in some
areas, and overburdened providers
in others.
Impact on Patient Care
Delayed treatments, patient
dissatisfaction, and potential for
worsened health outcomes.
Operational Inefficiencies
Suboptimal resource allocation,
increased administrative burden,
and revenue loss from missed
opportunities.
"Access challenges disrupt care delivery, impact patient outcomes, and strain resources
—resolving them is key to unlocking the full potential of ambulatory care."

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Optimizing Referral Management
Advanced Referral Analytics
• Track in-network and out-of-
network referral patterns
• Measure and monitor conversion
rates
• Identify primary care-to-specialist
leakage
Referral Performance Metrics Enhanced Provider
Network Management
• Identify providers with low in-
network referral rates
• Analyze outgoing referral patterns
for network optimization
• Leverage data for targeted
provider engagement
• Review referral-to-
appointment conversion rates
• Analyze referral processing
cycle times
• Track trends from internal and
external source providers

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1 Demand Forecasting Accuracy – Enhances predictive planning to align staffing with patient demand,
Optimizes resource allocation based on anticipated volumes, Improves overall operational efficiency
2
Appointment Analysis – Monitors appointment volumes by location, specialty, and provider, Tracks
monthly and annual trends relative to budget or goal, Measures patient access using third-next available
appointment metric
3
Comprehensive Data Integration – Merges data from multiple systems for a single source of truth,
Enables evaluation and improvement of scheduling processes, Supports optimization of patient
throughput and provider workload balance
Resource Planning Optimization

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Ambulatory Analytics Solutions
The Patient Access Module equips service-
line directors and practice managers with
insight they need to improve access,
effectiveness, and satisfaction.
The Referral Management Module provides
summary data as well as detailed views on
incoming and outgoing referrals.

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Best Approaches to
Align with Payor
Requirements in
Value-Based Care

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Poll Question #4
Within your organization what is the primary data &
analytic solution to support value-based care data driven
insights getting into the hands of your clinical and operational
teams?
a) Payer provided reports
b) Internal reporting solution
c) CIN/ACO provided solution
d) Vendor provided solution
e) No current solution
f) No value-based care participation

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Value-Based Care:
Health Care Value Alignment
Healthcare
System
Payer
Consumer
Incentive Alignment
Value-Based Care (Population Health)
strategically aligns incentives to
optimize healthcare spending,
enhance care quality, and improve
community health, ensuring
sustainable and scalable success.

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Impact of Value-Based Care
Budget Optimization (P&L)
Optimize revenue from Fee-for-
Service (FFS) and Value-Based (VB)
models, while managing efficiency,
quality, management fees, and
capitation.
Contract Value
Maximization
Balance FFS and VB revenue to
maximize overall contract value
through data-driven modeling and
performance management.
Market Penetration and Access to Lives
Improve member retention and drive growth by
enhancing the consumer experience and choice.

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Impact of Value-Based Care
Provider and Facility
Network Alignment
Strengthen the care continuum
by reducing care break points and
improving referral management
and care coordination.
Best-in-Class Quality and
Clinical Outcomes
Achieve recognition and high
ratings to attract consumers
(payers, employers, and patients)
through superior quality and
clinical outcomes.
Consumer Preference and
Experience
Deliver an easy-to-use, outcome-
improving, and cost-effective
experience to drive consumer
preference and satisfaction.

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Value-Based Care Solutions
Ignite Data & Analytics Value Optimizer MeasureAble
Pop Analyzer
Executive Dashboard Twistle Patient Engagment
Optimizing Your Value-Based Care Strategy
Driving Massive, Measurable Improvement Reducing Time Spent Managing Quality Data
Quickly Defining Custom Populations
Providing Organizational Strategic Plan
Performance Management
Engaging Patients with Personalized
Communication

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Enhancing Operational
Efficiency for Managed
Service Organizations
(MSOs)

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Poll Question #5
Which services do you think are most valuable when provided by
an MSO?
a) Billing and Coding
b) Compliance and Regulatory Support
c) IT Services
d) Human Resource Management
e) Operational Oversight

30. Managed Service Organizations on the Rise
1 Annual growth in MSO market driven by consolidation, aging population, rising demand for
specialty care, and tech investments.
2 Private equity surge due to significant investments, fueling market expansion.
3 Shift to Value-Based Care with MSO revenue expected from value-based
models by 2028, aligning incentives with improved quality and efficiency.

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MSO Focus Areas
Revenue Cycle
Comprehensive revenue cycle management,
including coding, billing, claims management,
and denial resolution.
Payer Contracting
Negotiating and managing contracts to secure
favorable reimbursement rates and ensure
compliance with payer requirements.
Pre-Service
Encompassing patient eligibility verification,
authorizations, referrals, and scheduling.
Practice Management
Offering operational support, such
as staffing, workflow optimization,
supply chain management, and
performance reporting.
Compliance & Credentialing
Adhering to regulatory
requirements, managing provider
credentialing, and maintaining
necessary licenses and certifications.

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MSO Solutions
Tech-Enabled
Managed Services
Lumeon Embedded Refills
PowerCosting PowerLabor VitalCDM VitalKnowledge
Ambulatory
Analytics Suite
Providing Labor Cost Savings Increasing the Financial
Outlook of Ambulatory Care
Automating Best Practice
Workflows
Providing embedded medication
renewal decision support
Managing the True Cost of Care Providing Timely, Actionable Data Organizing & Managing All Your
CDM Data
Providing Complete Coding &
Regulatory Information

33. Questions?
© Health Catalyst. Confidential and Proprietary.
Holly Burke | SVP, Practice Management and Physician Solutions
Sarah Roberts | SVP, Ambulatory Practice Management
JJ Geise | Chief Administrative Officer
Travis Simar | VP of Population Health and Payer Services
Alora Martin | Webinar Program Manager
Hcwebinars@healthcatalyst.com