In 2014, 8 million individuals signed up for health insurance through the federal health care marketplace. According to the most recent numbers released by the White House, more than 11 million signed up in 2015. With the boom of new patients to the market, Novant Health estimated that in the greater Winston-Salem area alone at least an additional 23 primary care providers would need to be added by 2019 to keep up with growing demand.
Higher volumes usually mean more compensation in the business world, but that’s not the case when it comes to health care. “The fact of the matter is, our costs are going up and reimbursements are going down across the board,” said Marty Lambeth, vice president of Novant Health Clinic Services. “As an industry, we need to find more efficient ways to deliver the same high-quality care and to shield our patients from any negative effects of our changing landscape.”
For Novant Health, implementing a lean footprint plan that uses low-cost resources to bolster convenient care is one way to maximize efficiencies and lower costs while also improving access for patients.
What is a lean clinic?
At its core, the focus of a lean clinic – named after the management principle – is convenient care that is often placed in locations where coverage gaps exist. “We want to provide the care the community needs where and when they need it, whether that’s a primary care office, urgent care or retail clinic,” Lambeth said.
As part of the lean footprint plan, Novant Health has analyzed every part of the clinic experience – from who works there and where it’s located, down to where the printer is placed in relation to staff work spaces. To reduce costs, Novant Health has reduced the footprint of lean clinics by utilizing modular equipment and removing conference rooms and individual physician offices.
Novant Health’s original lean clinic, Wallburg Family Medicine, opened in 2013. Some locations take on multiple roles as needs change. Novant Health Friedberg Family Medicine in Winston-Salem, N.C., operates as a primary care clinic during regular business hours. It is staffed by one physician and one certified physician assistant. At 4 p.m., the after-hours clinic physician assistant arrives and the clinic begins taking walk-in appointments. At 5 p.m., the regular clinic staff heads home for the day, but walk-in care continues through 8:30 p.m.
“We are essentially running two separate clinics out of the same space, eliminating the need for overhead costs on a second location,” Lambeth said. “In our stand-alone locations, we have developed a floor plan that maximizes square footage and minimizes cost.”
Changing the staffing model
An integral part of moving to the lean footprint model for Novant Health was making a shift in how clinics are staffed.
“Everyone benefits when our staff members are working at the top of their license,” Lambeth said. “By utilizing highly skilled nurse practitioners and physician assistants under the guidance of a physician, we can provide basic care at a lower cost and allow our physicians to focus on more complex cases.”
To meet the growing need for advanced practice clinicians in the lean footprint model, Novant Health has proactively built relationships with schools and nursing programs across our market areas. In addition, redundancies have been eliminated in the credentialing process so that new graduates can transition into the workforce more quickly.
“The demand for primary care is still increasing and we’re struggling to keep up,” Lambeth said. Within three months of opening, Wallburg Family Medicine surpassed patient volumes projected for its first year.
“As we move into a population health model of care, we need to continue to close the gaps in patient access,” Lambeth said. “The lean footprint model has proven to be an effective tool to help us achieve that goal.”