Building an Integrated Ambulatory Enterprise at a Major Academic Health System

The University of Kansas Hospital and the University of Kansas Physicians sought to integrate 18 independent clinical departments into a new health system to prepare for the realities of the post-reform healthcare market. Upon integration, the newly formed University of Kansas Health System (UKHS) would employ and manage more than 500 providers across 78 practice locations and account for over $500 million annually in revenue.

While all of the individual entities had worked closely together for decades, the new health system did not have a single platform to manage physician practice and ambulatory operations across its expanding outpatient network. To realize the true potential of integration, UKHS would need a structure to unify the management of practices that had largely operated autonomously. In addition, the new management structure would require the development of substantial infrastructure, ranging from revenue cycle and access systems to reporting competencies, in order to effectively guide an organization of this scope.

Leaders across the entities recognized that the new ambulatory enterprise required substantial investment and a structured approach to development. They asked ECG to evaluate the outpatient operations across the ambulatory enterprise and identify opportunities to bring best practices and centralized leadership to the newly formed organization.

ECG began by conducting a comprehensive assessment of ambulatory operations across several core areas of performance, including provider production, access, space utilization, cost, and revenue cycle performance. Using the findings of this work, ECG worked with physician, department, and hospital leaders to identify opportunities to realize value under a unified management structure after integration.

Upon completing the evaluation and design of the new ambulatory enterprise, ECG led stakeholders in building the supporting infrastructure to drive ambulatory best practices after integration.

Over the following year, ECG deployed a project management team of firm experts to help the organization establish a leadership structure and provide interim management until key leadership vacancies were filled.

The project management team, under a core group of executive leaders, helped create implementation work groups composed of stakeholders from core functional areas to develop processes to support post-integration operations, including:

• An ambulatory human resources group to develop the structure, performance targets, and processes to recruit, retain, and grow clinic staff.
• An information technology group to identify the systems and structures that would be required to support post-integration operations and an action plan to ensure that providers received support throughout the transition.
• A strategic planning group aimed at communicating business planning activities and shaping the framework for allocating space in the new ambulatory enterprise.
• A quality and patient experience team charged with performing a comprehensive survey of quality programs at the department level and identifying the resources needed to manage quality and patient experience in the new ambulatory model.
• A financial operations group focused on developing the processes and tools to manage an integrated revenue cycle and complete timely and actionable financial reporting.

ECG also assisted in developing the recruitment and evaluation process for ambulatory leadership positions.

In January 2016, the University of Kansas Hospital and the University of Kansas Physicians voted to integrate and form UKHS. Through integration, ECG helped system and operational leaders to achieve several critical milestones:

• Created a dyad leadership model to manage ambulatory operations and strategy, and established key matrixed leadership positions to manage core functional areas.
• Developed a physician-led committee structure to prioritize strategic initiatives and set performance targets for physicians.
• Prepared a plan to standardize front-end clinic work flows ahead of the transition from IDX to Epic Resolute and Cadence across the ambulatory clinics.
• Identified an opportunity to enhance collections by several million dollars by reducing variation in physician revenue cycle performance.

The new UKHS continues to utilize the framework that was developed to shape and manage operations across its expanding network.