MGMA Insights: Optimizing Ambulatory Space Through Digital Health Transformation
Download MP3Well, hi, everyone. I'm Daniel Williams, host of the MGMA Insights podcast. In today's episode, we are previewing a session from the twenty twenty five MGMA Leaders Conference. It's part of a series. We really wanna bring awareness to that comp conference.
Daniel Williams:It's gonna be in, Orlando, September 28 through October 2. We're really, really excited about that. Alright. And we are joined today, by Dr. Alpesh Amin. Doctor Amin is associate dean for clinical transformation at UCI Health in California.
Daniel Williams:And Dr. Amin will share how to leverage digital health in virtual care templates to optimize ambulatory space. So first of all, doctor Amin, welcome to the show.
Dr. Alpesh Amin:Well, thank you. It's a pleasure to be here.
Daniel Williams:Yeah. I it's so good to have you. We were talking a little bit offline. I know that, you've been busy. I've been busy, but we worked out our schedules.
Daniel Williams:And I love it that, we're having an opportunity to talk to you. So first of all, just tell us a little bit about your background in health care and how you, wound up at UCI Health. Any highlights you might wanna share with us?
Dr. Alpesh Amin:Well, thank you. You know, I started my career kind of having had some experience in the startup world in both bio and tech. You know, came to UCI for training. Yeah. You know, started our hospital medicine program and division here, served as chief of general internal medicine, and then became vice chair for clinical quality and ultimately chair of medicine at UC Irvine where I spent, three terms or sixteen years doing that.
Dr. Alpesh Amin:And then and now I'm associate dean for clinical transformation. Also, do a lot of real world, evidence, both to drive better health care delivery, technology, and health care, as well as, yeah, both precision health and population health. And, you know, how do you make things better for people? Right? You know, as they're as they're accessing health care is is really, really important.
Dr. Alpesh Amin:You know? So I kinda bring the worlds of, have background in, engineering and in business and and obviously medicine. So I kinda try to bring those three worlds together to do public good if I can.
Daniel Williams:That is wonderful. And it dawned on me, that you're at UC Irvine when you mentioned that, and I had had read that earlier as well. Back from 2000 to 02/2003, I was working in a building just just across the street from the campus. Wow. Yeah.
Daniel Williams:I was in the media at the time. I was working at the Orange County Business Journal, writing about real estate there. And, I used to sneak over on my lunch breaks to that In N Out, burger place. It's right there. And it was always about a thirty it took me the entire lunch break to just sit in the line and get my burger and go back
Dr. Alpesh Amin:to my desk,
Daniel Williams:but it was worth it.
Dr. Alpesh Amin:So it was good. Yeah. I have a lot of I have a lot of international friends when they come into town, believe it or not. They like going to nice restaurants, but they always wanna stop off at In N Out Burger at some point during their trip.
Daniel Williams:Well, it is a unique sort of place, but that is that is so cool. So, in reading about your session, you really are at the leaders conference. You're gonna be focusing on ambulatory space optimization. Just in a general way, just define that. What does ambulatory space optimization mean to you?
Dr. Alpesh Amin:Well, for me, it means, it it it means access to care. Okay. Right? You know, how do we, ultimately, bricks and mortars is limited. You can't keep building bricks and mortars to to achieve opportunity in terms of access to care.
Dr. Alpesh Amin:And as patients continue to devolve and age and, have challenges, there may be other ways that they need access to care. Right? And, and as we move to more real time care delivery, you need, which facilitates access to care, there's ways that we need to think about doing things differently. Right? And so, that could be the use of telehealth and technology that could be having cured delivered at home.
Dr. Alpesh Amin:You know? So there's a lot of different, using digital health, empower and there's this idea of empowerment that also, you know, patients, as they feel more empowered to help in their care delivery, you hopefully will will see them own it more, continue, to be engaged in it. And we know that engaged empowered patients, generally, will will do better in terms of their quality and outcome over a long period of time, especially for things like chronic illness. I, you know? So so the ambulatory setting is a very unique setting in the sense that you you wanna be you have some control over, the ability to optimize, and that includes everything from templates to bricks and mortars to space efficiency to, you know, working at the scope of your license, when you have a multidisciplinary team involved to thinking out of the box in terms of, delivering care where the patient may not be actually in front of you at that moment in time.
Daniel Williams:Yeah. That those are some great points there. So in reading about your, presentation in your notes there, you noticed some challenges when you got to UCI Health. What were you seeing there? What stood out to you that went, okay.
Daniel Williams:We do need to make a transformation here. We need to adopt some of these new practices if we really wanna meet patients where they are.
Dr. Alpesh Amin:So in some sense, UCI Health has also been on the forefront of of, thinking out of the box and using I mean, we've developed over the year over the years, we've developed tools that will help in terms of patient care delivery, you know, it may be non patient facing, where like e consults, in the ambulatory space. And we've had, great success with that. Our, what we have a one day business day turnaround on e consults. Think about you trying to get in to see a specialist, how many days or weeks it takes you to actually get an appointment. So e consults, you know, in one business day is phenomenal.
Dr. Alpesh Amin:And eighty five percent of or or so of those consults are successful. Right? So patients can be at home while that actually happens. Telehealth and the versions of telehealth, we we utilize that, then we can talk more about the kind of the COVID, experience that we had, but that also allowed us to, think about bringing business what we call business continuity back in. Right?
Dr. Alpesh Amin:So as COVID was, getting more and more control, one of the things that we needed to do was rebuild our patient access in the ambulatory setting. So at that time, I was chair of medicine and I, co chaired a process with our, one of our ambulatory directors. And it was, we were able to hit we were asked to get to 120% of budget in a matter of a couple of months, and we actually did it within a month. Right? So it was, and that that was transformative in terms of the process and how we rolled it out.
Dr. Alpesh Amin:But, you know, I think if we kinda look at this, we're never gonna have enough space for all the physicians and APP, nurse practitioners or PAs, to practice. And so we need to think about how to incorporate technology in terms of the delivery that allows patients to feel continuously connected. I'll I'll repeat that. Continuously connected with the health system that they're they're engaged with.
Daniel Williams:Yeah. I appreciate that. And then that leads right into my next question, and I really wanted to ask you about that. In reading about y'all's case study, you put together this digital transformation. You were in in the notes, it says you were able to expand clinical teams, but you didn't you did that without having to build new physical space.
Daniel Williams:So talk about that, that expansion and what innovation you did, or what did you do so you didn't have to, like, add on to the space that you had already.
Dr. Alpesh Amin:So I think it was multifactorial that we did. We we had patients that were discharged from the hospital with COVID. We actually implemented a remote monitoring system where we were connecting into patients, able to, measure their oxygenation, measure, certain vital signs of the patient. You know, certainly, they had to know how to use an an you know, a smartphone or smart device in order to do that. But but those that could and we actually published an article that showed through remote monitoring with well developed criteria workflows and and technology and education, we were able to drop the length of stay for patients in the hospital by a day while not adversely affecting our readmissions, or visits to the emergency department.
Dr. Alpesh Amin:So that was highly successful, but it also meant that we were able to keep patients at home and provide care to them that they didn't have to wrap around to come back for an ambulatory visit, and we could have that ambulatory visit available for other patients that needed it. Telehealth, you know, your traditional over Zoom, or whatever platform is being used, we did a lot of that kind of work, with patients in order to, facilitate care delivery. We had, developed some digital online, scheduling platforms for patients. We made labs and other, you know, results available online and accessible to patients through our MyChart systems. You know, we even had, in order to prove efficiency when a patient showed up at UCI Health, they would show up in a parking lot, and, they were able to connect in with the with the nurse who would come out and do the intake while they were in the parking lot in order to keep both social distancing occurring as well as allow patients to, allow the intake, the the it's a little bit of history and other thing getting done.
Dr. Alpesh Amin:I mean, you can you you know, other industries have done some of these things. Right? You know, you think about drive throughs, when patients got I mean, you talked about In N Out earlier. Well but if there wasn't the drive through, think about how long the lines would be without drive throughs. Right?
Dr. Alpesh Amin:So so, know, you think about but that there's new technology that you need to have in order to be able to facilitate that process. As long as we were able to register the patient at the appropriate site site, which we were able to do, we could utilize a virtual platform. It could be, patients at home while, you know, the physician was in their office, academic office, so that they weren't in the clinic so somebody else could use the clinic. Right? And so there was different, strategies that we used.
Dr. Alpesh Amin:And as I mentioned earlier, our outcomes, were just tremendous, as we engaged, everybody in the process.
Daniel Williams:Alright. So you are giving us some great examples around that pandemic time and some of the innovations that were being implemented then. As we're seeing, technology is continuing to evolve. Health care is continuing to evolve in the way they meet with patients, whether it's in person or virtually. So talk about that.
Daniel Williams:How are you currently managing workflows and those faculty expectations, your staff to maintain a high quality experience? You bring in that from both sides of it so, both the patient and, the employees and the staff feel good about those interactions and the care that's being delivered.
Dr. Alpesh Amin:Yeah. You know, it's a interesting thing. Right? If you're gonna go play for a national football team or a basketball team or you're gonna go to the Olympics or whatever, think about the training that's done from a team perspective, you know, pretraining and scrimmaging and all that stuff. It's done once in advance before you start, you know, real time play is actually current.
Dr. Alpesh Amin:In health care, we don't do that. Right? In health care, we throw people into the sandbox and say, figure it out while you're doing what you're supposed to be doing in terms of health care. You know, I think as we've continued to evolve, we've kind of set clearer clearer and clearer expectations of different people's roles. We've kind of helped people understand that health care is a team sport, not an individual sport, and, you know, how to delegate certain responsibilities.
Dr. Alpesh Amin:Always in any team, there's gonna be kind of the captain of the ship. Right? But besides that, then the rest of the team is, is kinda is supporting the the process, and everybody has an important role in that process. And so we've kind of encouraged that. We are a big believer in, the multidisciplinary care.
Dr. Alpesh Amin:So, you know, the doctor doesn't shouldn't have to spend their time trying to educate about, about social work needs or dietary needs or whatever. You know, the the practice should have those types of resources available. Now they also don't actually have to be all on-site either. Right? They could be referrals.
Dr. Alpesh Amin:They could be telehealth. They could be go down the street, and somebody will be able to see you. I mean, there's all kinds of different variations of that. But but having access for patients to the multidisciplinary team, I think, is really, really important. And that the communication between the multidisciplinary team is important.
Dr. Alpesh Amin:So we're using things like, Teams and, Epic Chat and and other tools to help facilitate the communication between the multidisciplinary team around a single patient so that, you know, info critical information is not lost. Right? You know? Yeah. The more information I know, the better I can make a decision about the patient when my when I'm being asked to step to the plate.
Dr. Alpesh Amin:Right? And if I can hand off that information like a baton to the next person, then they're stepping up to the plate, in an easy way if I can transmit that information, they can do their job better too. Right? And that creates camaraderie. That creates an opportunity for people, but you need the tools, to help facilitate that.
Daniel Williams:Right. I wanna ask a question about the patients themselves. Have y'all done studies, any research to get a feel for how the patients have responded to y'all's transformation and the way they're being treated?
Dr. Alpesh Amin:Yeah. I you know, we've done we've done different types of research. You know, where do patients want to get do they wanna use digital health, or do they want to go to a traditional ED urgent care, you know, office visit to to get their care delivered? Right? And what are the demographics of the types of patients that want it one way or the other?
Dr. Alpesh Amin:What's the cost associated with doing it, one way or the other? Right? Let's do our patients and using technology to facilitate their health care. And, you know, we've been actually quite nicely surprised that actually, you you know, maybe there was a time when you might have thought that the younger generation was more apt to using tech and the old the more elderly generation would be less, you know, interest in using it. But I think our studies and research have shown that, more and more people, even as they age, are are utilizing tech to facilitate their health care delivery.
Dr. Alpesh Amin:And, whether it is just convenience factor. I don't wanna have to leave my house to go and get the to do get my information or to talk to somebody. Or whether it is, something to do, you know, at home using devices and tech to allow for it. Of course, there's also yo. You don't want people testing medicine on their own.
Dr. Alpesh Amin:And I actually think the world of AI is gonna change a lot, is gonna impact this in a great way, and, you know, we should, we should be on the forefront of of trying to figure out best practices and the utilization of AI for better and more efficient health care delivery that optimizes quality.
Daniel Williams:Yeah. Fine. Thank you so much for that final question then. For any of our MDMA listeners who are considering implementing these practices into their their clinic, their system, what's some advice? What's some first steps that you'd wanna recommend to them?
Dr. Alpesh Amin:Well, my first thing is be open to the fact that there could be different ways of doing things. Right? And to create the team of folks that will work with you. It doesn't have to be a big team, but, a team to say, to ask the question, how can I do it differently to meet my goals? It could be a 10% growth, 20% growth in your in your practice.
Dr. Alpesh Amin:It could be, easier, at accessibility of patients to health care delivery, or to continuity. It could be the how to ensure, your no show rate is is as low as it can be. Right? So there's a lot of different, or how do you avoid, urgent cares and EDs, which are more expensive than office visits and and home visits and or or home care in some sense. So you can think about your goals.
Dr. Alpesh Amin:You can so I would set certain goals, make sure the entire team knows what goals you're trying to achieve. You don't have to hit all the goals in one year. You can this can be an evolutionary process of how you build on those goals to to get there. But but I I think it needs to be it needs to lead to accessibility. It needs to be customer friendly or patient friendly, and it needs to be coworker friendly in terms of, how you are building systems to drive, better delivery in health care.
Dr. Alpesh Amin:And I would I think it starts with identifying your goals, identifying your team, getting everybody, on the same page in terms of what you're trying to accomplish, and then boldly going to accomplish that. Right? And and do an iterative process of of understanding where gaps are every step of the way and close those gaps and and, and hit your successes, celebrate your successes and your wins as you're continuing to move forward. And at the end of the day, the patients are the ones that will win, and that's that's what we want.
Daniel Williams:Love it. Alright. Well, doctor Amin, I wanna thank you so much for joining us today on the MGMA podcast.
Dr. Alpesh Amin:Well, it's my pleasure, and thank you for including me.
Daniel Williams:Alright. So for those attending the twenty twenty five MGMA Leaders Conference, be sure to check out doctor Amin's session. It's titled "Ambulatory Space Optimization with Digital Health Transformation. Now I'm gonna put a direct link to the event in our episode show notes. You can click right to it and read more about it and register and hope to see y'all in Orlando and be on the lookout for more interviews with our leaders speakers.
Daniel Williams:So until then, thanks everyone for being MGMA podcast listeners.
