Advanced Practice Providers + Technology = Tomorrow’s Workforce Solution

Editor’s Note: Sg2 Principal Mark Larson and Sg2 Senior Consultant Katie Elia contributed to this post.

With nearly 52,000 additional primary care physicians needed by 2025 to meet health care demand and today’s mean internal medicine physician salary at $279,888, the provider access and economic workforce challenges are obvious. To overcome these barriers, innovative health systems are developing tech-savvy approaches to unleash the top-of-license potential of advanced practice (AP) providers.

Combining disruptive technologies with top-of-license practitioners can create a new, more powerful virtual asset to combat limited provider access and rising health care costs. Technology and artificial intelligence (AI) are evolving rapidly, and organizations need to ask key questions to determine opportunity and best fit.

1. Can the gaps between unmet consumer demand and limited provider supply be filled by adding virtual support for AP providers?
2. Can the consumer’s route to a clinical decision be streamlined by technology?
3. Are there opportunities to infuse the care process with AI, alert clinicians to appropriate potential therapies and support clinical decision making through smart tools, saving time and money?

Building your tech-enabled AP strategy requires a strong understanding of future consumer demand, current access challenges and the economic challenges of staffing. The following tech-enabled AP workforce strategies have been implemented by others and may be worth investigating.

Embed Intelligence Into Virtual Urgent Care Offerings
Increasingly, patients are adopting virtual care to meet their low-acuity primary care needs. In high-growth and resource-constrained markets, using a face-to-face virtual approach to meet new virtual health demands improves access, but does little to improve provider efficiency. By empowering AP providers with AI-embedded technology, innovative organizations are enhancing provider productivity and improving consumer convenience. For example, Greenville Health System (GHS) in South Carolina began offering a new telehealth service called SmartExam through a partnership with start-up Bright.md.

SmartExam is a consumer-facing web portal that collects patient data, then combines the information with the patient’s medical record and screens for potential diagnoses before the involvement of a GHS AP provider. After the patient completes their information, the technology submits data to the AP provider, who determines the appropriate diagnosis and implements a treatment plan. GHS found that this process takes the AP provider 5 minutes (compared to the typical 15 minutes for face-to-face virtual visits), which allows AP providers to see 150 to 200 patients per day, with a patient cost of only $20—which consumers love. The takeaway: empowering AP providers with technology and low-cost and consumer-centric solutions can combat access constraints and enhance workforce capacity.

Empower the Provider Workforce at Acute Care Sites
The cost of hospitalists and intensivists continues to mount, and hospitals are seeking strategies to ensure economical coverage for inpatient units. For Emory Medical Center, it was not feasible to have a full complement of 24/7, in-house residents and intensivists providing coverage for critically ill patients. To ensure appropriate coverage, the teleICU team (staffed by tech-enabled AP providers) provides monitoring coverage when the intensivist is not on-site (nights, weekends, holidays), as well as providing additional monitoring for highly critical patients and on-site staff alerts for anomalies or deteriorating conditions. Through this model, high-acuity units maintain 24/7 high-quality coverage without the high cost of 24/7 physician coverage, resulting in reductions in ICU and overall hospital LOS and mortality. Tech-enabled AP providers working at top-of-license enable physicians to practice at top-of-license, and health systems avoid layering on extra labor costs without return on investment.

Build Bridges to Locations With Limited Access
Rural communities make up almost 20% of the US population but contain less than 10% of the nation’s providers, creating a tremendous access gap. Emergency department services are essential in many small communities, and physician shortages can be a huge stressor on the region. Forward-thinking US health systems serving rural populations are building tech-enabled AP solutions to meet access needs and optimize their workforce through top-of-license practice. University of Mississippi Medical Center (UMMC) extended its brand, reach and referral channels to rural areas through innovative use of telehealth coupled with progressive use of AP providers.

UMMC’s TeleEmergency program provides technology support allowing AP providers to independently treat 56% of the ED patient population with low-acuity conditions at affiliated critical access hospitals. For patients with higher-acuity or critical conditions, AP providers teleconsult in real time with UMMC specialists. Not only did AP provider usage enable more patients to remain in their communities for less complex care, but the transfer process was also streamlined and expedited. This program and other, similar tech-enabled AP strategies represent financially sustainable staffing and technology solutions for reaching remote locations.

Health systems assessing expansion of their use of technology-enabled AP providers should consider the following:

• Determine market fit. Understand the market’s appetite for same-day access; identify acute and ambulatory provider gaps; and determine opportunities to expand access and quality, lower costs and improve margins. Without the benefit of a strong market assessment, simply inserting AP providers into the care process can add extra cost to an already expensive care model. 
• Recognize the value of AP providers. Evaluate each potential site identified by your market assessment to prioritize locations that would most benefit from AP providers. Consider piloting efforts in areas where there is a mismatch between consumer needs and the providers’ skill sets, where access is limited by gaps in care, or where acute care cost and coverage are a challenge.
• Redesign the care process to ensure efficiency. Assess care process opportunities, model an optimal staffing mix and develop workforce strategies to ensure a future supply of AP providers. Prioritize opportunities where AP providers can bill for services, productivity can be measured, and AP and physician alignment models can foster top-of-license integration. Populations with a high penetration of value-based care may be an optimal starting point to insert AP providers armed with real-time monitoring and virtual access, who can focus on chronic populations and/or deliver low-cost virtual care. 
• Weigh technology investments and partnerships. Technology partnerships may yield the best bang-for-the-investment buck as third-party organizations begin directing more AI investments to tools that augment provider efforts. Consider piloting new virtual tools that empower consumers to enter information up front, as well as future AI tools that help screen potential diagnoses. These innovations will be game changers for tomorrow’s workforce.

For more information, as well as case examples from leading organizations, Sg2 members can access our report Optimizing the Use of Advanced Practitioners.

More Sg2 Member Resources:

• Sg2 Webinar: Consumerism Outlook and Update: Building a Consumer-Informed Access Strategy
• Sg2 Webinar: Workforce Planning: Acute Care Considerations
• Sg2 Report: Inpatient Workforce Planning
• Sg2 Report: Ambulatory Workforce Planning—Mastering Multiple Variables
• Sg2 Report: The Next-Generation Technology Platform

Not an Sg2 member yet? Contact us for help with the successful and innovative deployment of AP providers, as well as workforce planning and strategy.

Sources: Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. 2011; Pettersen SM et al. Ann Fam Med. 2012;10:503–509; Pharos Innovations. Social determinants of health: understand and address the non-clinical factors driving healthcare utilization. 2016; Basu S et al. Ann Intern Med. 2015;163:580–588; Bright.md: Improving access to primary care. February 26, 2016; Patel K et al. Transforming rural health care: high-quality, sustainable access to specialty care. HealthAffairs Blog. December 5, 2014.

Tags: advanced practice providers, AI, APs, economic workforce challenges, provider access challenges, tech-enabled AP strategy, workforce planning, workforce strategy

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