"What we've built is an integrated system, so the front door to our system is our clinics. If we can get patients through the front door … that puts them in the outpatient setting and, hopefully, we can keep them in the outpatient setting," says Allen.
One challenge to Winona Health is opening up schedules to accommodate patients who want to come through that front door. It's a familiar cry heard from organizations that bring in once-independent primary care physicians and specialists under the umbrella of one system.
"We had 27 different types of patient appointments," he says. "So we couldn't do anything in a standard way … we had all these scheduling rules."
Using Lean management techniques, Allen says, Winona is working on standardizing schedules and also improving the patient flow to associate providers instead of the physician. He says in three years they're aiming to show a 20% increase in patients based on a strategy of involving midlevel providers who can free up the doctors to work on the most complicated cases.
"From a financial perspective, all the payment is built on surgery, lab, x-ray, pharmacy; that's where the gravy is. But, in a population health world going forward and a value-based payment [world], the reasons are going to change. But the premise will be the same because that is the front door. We're trying to think of what's the new front door besides the clinics."
For Winona Health, the new front door may open to another organization entirely. Allen says the system is contemplating a partnership with the local YMCA. The partnership would mimic the one that Clive, Iowa–based Mercy Medical Center has with its local Y for medically integrated services. The partnership with the Y is a natural fit, says Allen, because both organizations aim to keep people healthy. For Winona Health, that also means keeping them in outpatient settings as long as possible.
"We're getting paid if somebody's sick, we're not getting paid if somebody's well—but you have to make that switch somewhere; you have to make the change," says Allen.
The potential Y partnership is part of Winona Health's strategy to introduce a new health and wellness service line, which, Allen says, is still in the planning stages; but with value-based payment systems ahead, organizations must develop more financially feasible ways of caring for patients.