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Health systems are turning to ambulatory strategies in response to patient expectations for convenience, workforce shortages and financial pressures, according to a new report from the Center for Connected Medicine (CCM) at the University of Pittsburgh Medical Center and KLAS Research.
From outpatient centers such as ambulatory surgery centers to virtual platforms, care strategies are shifting.
The research, “Moving Outside the Hospital: Ambulatory Care Strategies at Leading Health Systems,” focuses on how large systems are providing more care in communities, outside of traditional inpatient settings.
The top types of ambulatory clinics, in order, are primary care clinics, specialty care clinics, urgent care centers, ambulatory surgical centers, diagnostic imaging centers, pharmacy retail clinics and employer-based clinics.
Respondents consistently reported the following service lines as top ambulatory investment priorities: primary care, cardiology, oncology, orthopaedics and gastrointestinal care.
Health systems have previously focused solely on increasing their geographic footprint. Now, health systems are driven by markets and service lines that have the most strategic importance or the strongest demand among patients, the report said.
Most respondents are investing in high-growth or underserved markets. Common areas of focus are multispecialty clinics, ambulatory surgery centers and virtual care platforms.
Strategies to shift care away from inpatient settings include virtual care and hospital-at-home programs. Both are currently facing reimbursement challenges from the government shutdown.
Investments, in order, include selectively investing in high-growth markets, aggressively expanding and building new sites, maintaining the current footprint with modest upgrades, and divesting or consolidating ambulatory locations.
Interviewed leaders say their health systems offer a broad range of outpatient services, including primary care, specialty clinics, urgent care, ambulatory surgery centers and diagnostic imaging.
Fewer organizations offer pharmacy retail health or employer-based clinics, though some are experimenting with these models in specific regions.
Healthcare leaders from midsize and large integrated health systems across the country were surveyed for the report.
Oversight of ambulatory care is becoming more centralized at the executive level, the report found.
The structure of ambulatory leadership varies. Some have formal ambulatory divisions led by dedicated executives or physician leaders. Others integrate ambulatory oversight into broader service lines or medical group structures.
Regardless of the approach, the goal is to ensure internal alignment around care access, efficiency and long-term sustainability, the report said.
Survey respondents are 44% C-suite level executives, 36% other executives and 20% senior directors, directors or managers. The majority of organizations, 76%, had more than 1,000 beds.
Email the writer: SMorse@himss.org