The Rationale for a Vice President of Access

Of the 83 academic health systems¹ serving adults in the Patient Access Collaborative, 25 have roles that are designated as vice presidents – and that number is rapidly growing. Indeed, several of our member health systems recently posted new senior-level roles like Johns Hopkins Medicine’s Chief Patient Access Officer.

The vice president of access position is relatively new, beginning during the period of 2015 to 2017, according to our historical records. Although the field of ambulatory access arguably originated as call management was consolidated in the early 2000s, the leadership role was not elevated until health systems recognized that this activity was only the initial manifestation of opportunity. To that point in time, the ambulatory enterprise had historically been disjointed and managed via silos. The consolidation of access is almost exactly 20 years after the same phenomenon occurred with professional fee billing, starting with charge entry being centralized across the ambulatory practices – then realizing the benefit of focused management of the revenue cycle. 

This migration into a more senior-level position reflects the evolution of the role itself, from a tactical one to incorporating key strategic opportunities for the health system.

Having a VP of Access signals both internally and externally that the organization is committed to treating patient access as a strategy, not simply a transaction. It allows the perspective of access to have a seat at the table when setting organizational priorities. Historically, the focus began with the patient when they were sitting in the chair. [However,] the reality is [that] the journey to getting into that chair is…filled with challenges, both driven by changes in consumerism as well as consolidation of networks. Having a VP of Access ensures that the organization is [considering] how to think more upstream and be able to respond to both today and tomorrow’s health consumers. The [role] distinction allows an organization to recruit and hire a forward thinker who has a strong foundation in operations so that any work to onboard patients complements the overall throughput strategy.

Contributed by Kelly Turner, MHA, who was appointed in the newly-formed position of Vice President, Patient Access Programs at Memorial Sloan Kettering Cancer Center in 2023.

The leader over ambulatory access addresses quality and safety, growth, competitiveness, communication, and capacity management from the lens of the ambulatory enterprise. Because the ambulatory setting establishes an opportunity to manage patients in a convenient, low-cost manner, access represents the front door to the health system. With the elevation of risk as a major factor for purpose-driven health systems, the ambulatory enterprise serves as a crucial element of population health management.

The importance of the role emanates from its value to the health system as it relates to five key elements:

1. Quality & Safety: Timely access to care for all is fundamental to quality and safety. According to the National Academy of Sciences, “leadership is necessary to ensure that in each health care setting, practices are anchored in the basic access principles.” Because the patient’s journey to accessing ambulatory care remains largely outside of the health system’s lens, it was not historically targeted as an opportunity. The role of a health system as it relates to population health cannot be effective without timely access to ambulatory care, and equitable access requires a discerning, intentional approach to creating and sustaining consistent, reliable systems of care delivery.  
2. Growth: New patients are essential to the health of an academic health system; inpatient growth has stalled (relatively), with ambulatory volume progressing at unprecedented levels. Patient demand supersedes supply. Without intentional management of access to ambulatory care, progress may stall – or simply be the wrong growth for the health system. For example, growth in a particular specialty in ambulatory that has no corresponding capacity in its procedure rooms requires attention; if patients are being readmitted to the hospital due to lack of transitional care management opportunities, how can that gap be effectively addressed? “The VP level is able to provide organizational influence on strategies focused on growth and volume for the organization by partnering with other key system roles,” according to Philip Quick, MPS, CHAM, Vice President, Access Operations, Rush University Medical Center. A strategic leader recognizes the value proposition of ambulatory access – and, importantly, its interplay with the system’s continuum of care, while also being mindful of and deliberately addressing the structural inequities that disproportionately affect the most vulnerable patients.
3. Competitiveness: Patient choice has a major impact on the ambulatory enterprise; the leader understands the impact of consumerism – and recognizes that the health system cannot effectively compete without a convenient, frictionless entrance to the ambulatory enterprise. Geography no longer defines the borders of a health system’s market, thus requiring a transformative approach to community engagement to maintain the system’s competitiveness within the new industry structure.
4. Communication: Call management remains the hallmark of ambulatory access, yet the leader recognizes the real opportunity in understanding the nature of the call itself. Can the call be handled without human touch (self-scheduling, RPA, etc.)? Does the call represent a second (or more) call; why wasn’t first-call resolution achieved? How are calls from referral sources handled? How should agents be trained to manage the balance between the caller’s language, knowledge, etc. – and the system’s goal to get the “right” patient in the “right” slot. The list is endless, but the equilibrium of executing a successful infrastructure to handle calls – and, increasingly, other modes of communication, while delving into solutions to improve the handling of them, is crucial.
5. Capacity Management: The promise of capacity management is only realized with strong leadership, as it addresses the very core of the ambulatory enterprise’s greatest asset – providers’ time. Time management – which is typically codified via templates, thus referred to as template management - must be handled delicately, diplomatically, and deliberately, particularly crucial at present, given the reality of provider fatigue. The scope includes building the technical solutions – or developing them through partnerships. “[In my role,] I advise senior executive leaders on system-wide solutions that improve the patient and provider experience with access to care, including capacity management solutions,” reveals Ashley Arey, Vice President of Care Access & Service Integration at UNC Health. This area of access – arguably the “supply chain management” of the health system’s ambulatory enterprise – is largely unexplored and requires a thoughtful leader to successfully lean into it. That includes recognizing how to extract data – and presenting it to effectively to manage change.

One of the challenges for the role is that these elements are problematic to quantify – and difficult to effectively measure impact. That’s all the more reason why change management may be the most important responsibility of the newly-elevated role.

In the next episode of the PAC blog, we’ll explore the key asset of change management through these lens of senior access leaders.