Written by Dave Schafer

In New Braunfels, urgent care clinics and freestanding emergency departments are popping up to serve the expanding population in the second-fastest growing city in the United States. For low-level services like aches or injuries, more patients are going to the “convenient care facilities” rather than seeking care in an emergency room.

But while offering convenience, those clinics and FSEDs don’t offer higher-acuity level services of New Braunfel’s inpatient hospital, Resolute Health Hospital. So Resolute connects with those facilities as they’re opening and ensures they have a list of services the hospital provides.

Tripp Lyles

“The people at those facilities know that when they pick up the phone and call us, we’re going to respond immediately and quickly take that patient for the care they need,” said Tripp Lyles, Resolute’s director of business development and associate administrator. “We make sure they know we’re a resource for them. We follow up with them on a regular basis to see how things are going and just make sure that when they need something, we’re their first thought.”

Resolute allows patients who come from a FSED to skip checking in at the hospital’s emergency department and go straight to the operating or exam room — getting faster service and avoiding a second ED bill.

Resolute’s approach reflects a new reality for hospitals: The need to adjust business development approaches to capture more referrals from independent “convenient care” sources.

An Increasing Source of Referrals
Ken Janda

“It’s definitely a changing world from the old days when I first got into the HMO business,” said Ken Janda, an adjunct professor in health care management at Rice University who has worked as an executive for health plans for more than 30 years and is on the board of two charity clinics, Christ Clinic in Katy and the San Jose Clinic in Midtown Houston. “Before, you had a primary care physician who made a referral to the specialist, or to a hospital, and it was all in a nice, neat network approach. That often does not exist today.”

According to the Urgent Care Association, there were 8,774 urgent care clinics in the United States as of November 2018 — an increase of 8 percent from the previous year. Those urgent care clinics handle approximately 89 million patient visits each year, which is more than 29 percent of all primary care visits in the United States, according to Business Insider.

Then, there are more than 1,100 CVS MinuteClinics that provide primary care services, and more than 500 freestanding emergency departments nationwide.

“I think most hospitals are recognizing they need to be connected to those organizations,” Janda said.

Those relationships should be reciprocal, though, he notes. For example, Christ Clinic has a good relationship with Houston Methodist West Hospital because that hospital can refer some patients to Christ Clinic for follow-up care.

“That is particularly good for hospitals whose patients are uninsured, underinsured or struggle to pay their bills,” Janda said. “Charity clinics have funding for some of these folks. It’s good for the follow-up and continuity of care, but it’s also the reality of how much uncompensated care a hospital can take on.”

Resolute’s process for clinics and FSEDs is reciprocal because it creates great customer service. “The patients are going back to that freestanding and say, ‘Thank you for that positive experience,’” Lyles says.

Focusing on the Consumer Experience
Paul Generale

“If I’m an independent ED, urgent care or primary care doctor, why do I want to use CHRISTUS Health System when I refer out? How is CHRISTUS making my life easier?” said Paul Generale, executive vice president with CHRISTUS Health System. “If I’m sending patients and they have to wait that reflects on me. So, for CHRISTUS, these facilities are consumers. We have to do more than just be located close to them in their communities. We have to offer high-quality care, ease of access and a positive experience to the referring physician and those we serve.”

CHRISTUS Health System has more than 60 hospitals that can be referral recipients from convenient care facilities. It also has its own network of primary care clinics that refer back to those hospitals.

In areas where it doesn’t have enough primary care coverage, though, CHRISTUS has signed up clinics and FSEDs with the best reputations as providers in the system’s health plan. Now, CHRISTUS Health Plan members can use those facilities and then be referred to CHRISTUS for higher-level services.

CHRISTUS is also in negotiations to formalize relationships with a retail pharmacy that provides an advanced nurse practitioner who can give flu shots and provide other services for its Medicare population, Generale says. The move will further expand the health system's primary care network in the communities CHRISTUS serves.

Barriers to the Partnerships

There is another dynamic hospitals must account for when building relationships with these new entrants: Competition for patients. So CHRISTUS markets to the community, emphasizing its integrated systems of care and ability to provide and document all phases of the patient journey — something patients who go to an unaffiliated clinic are unable to receive.

Shannon Stansbury

“One of the challenges is, if we have a primary care physician who sees a consumer and that consumer then goes to CVS to get their flu shot, now you’re back to fragmented care,” said Shannon Stansbury, CHRISTUS’ senior vice president of population health. “We’d like to know that information, but it can get pretty expensive to try to exchange data with organizations like CVS, Walmart and others.”

That’s another barrier when working with these independent facilities: Physicians in the hospitals must rely on what the patient says or duplicate testing to direct treatment or to update patient information.

“I think as an industry, technology and systems haven’t supported that connectivity,” Generale said. “They’ve done everything to say, ‘No, we’re siloed. We’re not going to share.’ It’s going to change. It is changing.”

A lot of people are trying to figure that out how to make that information-sharing connection, Stansbury said. When they do – when they can create a more successful health information exchange, for example – independent facilities and hospitals will be able to work together for coordinated care.

Greater Houston HealthConnect, which connects disparate electronic health record systems across 24 counties in southeast Texas to facilitate clinical integration, shows promise in that area, Janda said. “With the improvements of being able to obtain medical records electronically, sort of in real time, hopefully that will help the fast-track portion of this while providing cost savings because we don’t have to repeat lab tests,” he said.

Partnerships Offer the Way Forward

As hospitals adjust to a changing health care landscape, building and maintaining relationships and serving as a resource for independent facilities will be vital to capturing referrals, integrating care and improving patient outcomes.

“I am aware that some clinics and hospitals have fast-track programs (like Resolute’s) in place, and I think it’s a really good trend to try to set those up, both to improve patient outcomes and to track the patient’s previous experience of care,” Janda said. “This is where we need to be going.”