Courting a more effective ambulatory strategy? Access metrics are king.

If you want your ambulatory strategy to be successful, it’s all about your “A game,” with “A” representing the holy grail of healthcare: access.

No matter the type of ambulatory service, every provider knows improving access is a deceptively simple objective. In addition to determining the right geographic distribution of services (e.g. provider clinics, ASC, diagnostic, therapies, pharmacy and durable medical equipment), there also are considerations like integrating multi-modal access channels (such as virtual, retail and home), balancing service locations to efficiently deploy specialists, and ensuring your ambulatory footprint feeds into your larger service line strategy.

Those challenges have led some systems to reconsider a “hub-and-spoke” model: regional hubs that offer a range of services that provide specialized or localized care. The hubs — sometimes referred to as “big-box ambulatory centers” — often consolidate multiple services like diagnostics, therapies, ASCs, retail pharmacy, physician offices and other services to a single, or multiple targeted regional locations, serving as a one-stop shop for patients. These regional hubs also realize economies of scale, consolidating numerous smaller locations to a more comprehensive and convenient services model, while expanding the regional brand image of the health system.

Regardless of the specific strategy, the importance of building greater access has ballooned in proportion to the anticipated growth in the ambulatory market. According to the 2024 Vizient Impact of Change® forecast, outpatient evaluation and management visits are anticipated to grow by 15.4% over the next decade. The IoC estimates more than 4.5 billion encounters were expected to occur in the ambulatory setting in 2024, and in this decade alone, one-third of all hospital volume could shift into ambulatory, home and virtual visit settings. In the years ahead, ambulatory revenue is estimated to surpass 50% or more of total health system revenue as outpatient utilization continues to grow.

As health systems work to boost ambulatory access and market share, here’s a look at core driver metrics as the foundation for a growth forecast that guides and informs continuous refinement of your short- and long-term services strategy.

Metrics that matter: Build your foundation

In its 2024 compendium of strategies to improve ambulatory access and care delivery — based on 25 years of insights into health systems’ leading practices, obstacles and opportunities — Vizient Member Networks outlined foundational metrics to assess ambulatory performance.

“If you want to grow your ambulatory footprint, it’s about going back to the basics — particularly when it comes to integrating data to reveal if your access strategy is a successful one,” said Nicole Spatafora, AVP, performance improvement.

So, what are the foundational measures to consider for your performance scorecard? Some are traditional operating metrics, while others are slightly more qualitative in nature — but all are important to ensure you’re meeting patient and employee needs and advancing market share growth:

Appointment wait times: A top priority is to determine the average wait time for new and established office visits (for both PCP and specialist appointments), including first and second available appointments. Long wait times are a significant challenge in both primary and specialty care, and the importance of monitoring patient retention due to a lack of available appointments can’t be overstated. Tracking same-day appointments is a key indicator of access for patients with urgent conditions. Having operational processes to support this service capability is a critical differentiator, as is tracking no-show rates and patterns to ensure follow-up systems are working to reschedule those patients.

Capacity management: Profile patient volume to track how many patients you’re able to accommodate, including daily encounter volume by specialty, and the blend of new and established patient visit slots on the schedule. Space utilization also is a key metric to reveal if exam rooms and clinical areas are being used effectively (this can help you avoid costly — and potentially unnecessary — expansions).

Analyze data to determine if staffing issues are preventing efficient room utilization/throughput. Consider initiating a Lean workflow evaluation to determine the optimal workflow, including initiating pre-visit planning, the number of rooms by provider, the role of an APP to expand access, the potential benefit of scribes or ambient technologies, same-day quick visits and other flow enhancements to optimize room utilization.

Digital front door: Delve into metrics around patient adoption and use, including how easily patients can navigate online systems to schedule appointments, access care or interact with providers. Consider metrics from the patient portal solution (e.g. MyChart) including patient self-scheduling, messaging, script renewal messaging, virtual visits and appointment confirmations.

“You have to think about the consumerism piece,” said Courtney Furrow-White, senior performance improvement program director. “How user friendly are you? Are you revamping how patients navigate your website and schedule an appointment? Can they schedule it online or do they have to stay on the phone?”

But ease of access can also veer into overload, which is why you should analyze the volume and impact of portal messages on provider workload and burnout and consider AI applications to assist with response management.

Schedule efficiency: This can be slightly harder to measure, but an important qualitative strategy is to standardize approaches to appointment types, durations and scheduling templates across providers to maximize productivity and minimize inefficiencies. For instance, a West Coast-based provider created better clinic workflow by providing less restrictive scheduling templates and standardizing appointments to 15- or 20-minute blocks per specialty. They also developed more flexible scheduling by allowing patients to schedule through the online portal to increase provider fill-rates and enabled waitlist technology to fill gaps in schedules. Consider adopting a same-day quick visit walk-in service model for urgent conditions, leveraging nursing and APP staff, and monitor patient adoption.

Preventive care and quality metrics: Track compliance with preventive measures such as cancer screenings, immunizations and chronic disease management, and link access metrics with quality outcomes to demonstrate the impact of care accessibility on overall patient health. Monitor gaps-in-care metrics and referral and script orders to track patient compliance. Leverage scorecard data to assess how follow-up systems are working and what processes need improvement to boost quality metric performance.

Pulse checks and surveys: Regularly assess patient, staff and provider satisfaction with access and services, and gather feedback on new implementations (such as telehealth) to ensure alignment with patient and staff needs. Leverage the patient portal or other text survey messaging to build metrics of satisfaction.

“An added bonus of conducting pulse checks around new implementations is that you’ll often find your staff has ideas around enhancements you could make to improve the product or service,” Furrow-White said.

Panel size: Track the number of patients who are under active management by physicians and APPs — including in primary care and OBGYN — to ensure optimal patient treatment and provider workload.

Covered lives under management: This is an indicator of market relevance in overall population health. Consider the number and percentage of the population under active management by a PCP or specialist (based on actual service engagement) and demographics by age band. Map overall market by primary service area and secondary service area market segments and “micro-markets” where there is prime growth potential.

Referral retention: Monitor specialist, diagnostics or procedure order referrals to track compliance, capture and fulfillment. This vital metric is key to monitoring the impact of schedule availability as well as patient compliance. Also look at referral follow-up to ensure you are directing patients to available providers within your system for downstream services and making it easy for them to schedule appointments.

The future of ambulatory benchmarking: Where providers most desire deeper insights

At a January 2025 Member Networks Top Performers meeting, healthcare leaders from large IDNs identified access as the most critical metric to ensure an effective ambulatory strategy. Executive leaders described an “ideal future state” for access measurements that align with redefining what access means to healthcare — expanding the definition to include virtual visits, patient portal interactions and other non-visit-based care modalities.

They also highlighted a need for more integrated metrics to populate a monitoring scorecard, noting a difficulty in accessing consistent data due to fragmented EMR systems and varying reporting standards, particularly from non-employed physician groups.

Insights they described as top priorities include:

Chronic and preventative care: Metrics that reveal successes and/or gaps in managing chronic conditions (particularly diabetes and heart failure) are especially crucial, they said, as is preventing diseases through better access to screenings and vaccinations. The group also indicated a specific interest in pediatric care, such as lead screening, depression assessments and well-child visits, as well as metrics around pre-hospital vs. post-hospital stays.

Health equity and social determinants of health (SDOH): Integration of health equity measures and stratification of data to ensure fair access to care is seen as a top priority, as well as screening for SDOH to support holistic patient management.

End-of-life and advanced care planning: Incorporating metrics for advanced care directives, palliative care and ensuring patient preferences are respected should receive an increased emphasis, they said.

Provider wellbeing: The group viewed this as one of the most overlooked influences on access — highlighting it as integral to maintaining high-quality care — with suggestions to measure provider engagement and mitigate burnout.

Specialty care: Moving forward, there should be a deeper focus on specialty-specific metrics, especially for managing conditions like Alzheimer’s and ensuring access to treatments through specialists. The group also underscored measuring the efficacy of integrating behavioral health screenings into primary care.

Quality alignment across the continuum: There’s a necessity for metrics that span both ambulatory and inpatient settings to ensure cohesive care, they said.

Proactive health promotion: There were suggestions for metrics that show if nutrition, exercise and overall wellness are being properly promoted within communities. Additionally, top performers see a substantial need for primary — not just urgent — care on demand.

“We are fundamentally in the care coordination business,” said Member Networks Vice President Michael Busch. “Those health systems that rapidly innovate with models of population health leveraging digital health with convenient and attractive geographic locations are best positioned to grow market share and elevate market relevance. A focused strategy, robust metrics and speed to execute will be the game changers.”

Vizient Member Networks Vice President Nicole Gruebling also contributed to this article.

Discover how Vizient can help you gain deeper, more integrated insights to bolster performance across the continuum of care with tools like the Clinical Data Base, Operational Data Base, Procedural Analytics, EDGE and more. And learn how Vizient Member Networks can connect you with peers across the healthcare industry to share best practices.