Reconstructing an Outreach Program

Outreach programs help to define a hospital’s community presence and provide much needed revenue to move the laboratory from a cost center to a revenue-producing center. Nonetheless, outreach programs need constant care and feeding to remain viable in the marketplace. This article will discuss the structure of the integrated outreach program at Fairview Health Services, the strengths and weaknesses of its integrated outreach program, the effects of having the wrong people in the wrong job, and benign neglect. It will also cover the lab’s marketing strategy for making its outreach program the number-one choice for physician offices and the “ BHAG ” that Fairview put in place to make its program even more successful.

Coming On Board

“I’ve been at Fairview for a year and a half, and when I first got here, the outreach program was rearing its head. When I looked at the program, I saw that it was suffering from benign neglect—although not intentional,” says Priscilla Cherry, MBA , MT (ASCP), and president of Laboratory Services, Fairview Health Services. “There were so many other things going on that they just really didn’t have time to focus on the outreach program. As a result, outreach became my focus. The resounding answer from my boss as to whether they wanted to be in the outreach business and service the clinicians in our community was ‘yes.’ The reason I asked this question was because I needed approval to go out and spend some money to put the program back together and basically give it the attention it was due. I then proceeded to do a quick assessment as to what I would need to put in place to get it together. Keep in mind that outreach programs need constant care and feeding. It’s not something that you put in place and think it’s just going to stay that way. It’s continuous process improvement.”

What Is Your Mission Statement

First, you have to start out with a mission statement. “We are part of the community in Minneapolis, and although there are several other hospital systems, we have been around for more than 100 years. We’ve been servicing the community. It’s important that we continue to service the community and we want to improve, in essence, the health of the community,” she says.

Mission Statement

Fairview ’s mission is to improve the health of the communities we serve. We commit our skills and resources to the benefit of the whole person by providing the finest in health care while addressing the physical, emotional, and spiritual needs of individuals and th ei r families. We further pledge to support the research and education efforts of our partner, the University of Minnesota , and its tradition of excellence .

“We have a new CEO at Fairview. His vision is to service one-third of the state of Minnesota in 10 years. Recently, after touring some facilities, he told me that the laboratory is mission-critical. He understood the value that the laboratory provided to the organization. His comment r einforced that our outreach program, the laboratory program for that matter, needed to have a secure foundation in place as we moved forward. Outreach is definitely one of the areas that we will concentrate on because most of our growth today is in the outpatient arena. We are going to have to focus on that area of the population that we serve,” Cherry explains.

History and Background

Founded in 1906, Fairview Health Services is a not-for-profit integrated delivery system with corporate offices in Minneapolis. “In 1997, it merged with the University of Minnesota, and b eing part of an academic institution added additional complexity for us. We have seven hospitals, 37 primary care clinic, 56 specialty clinics, approximately 2,500 licensed beds, and more than 22,000 employees. Total operating revenues are about $2.3 billion.” Recently, Fairview underwent reorganization, and it is now segmented into four regions, with the hospitals and facilities divided by region.

At Fairview, there are quite a number of departments that actually function as system departments. Laboratory services is one of them, as well as the following:

● Pharmacy services

● Rehabilitation services

● Imaging services

● Dietary services

● Supply chain services

● Cardiology

● Human resources

● Orthopedics

● Oncology

“Businesses that go across the system are standardized. For instance, the laboratories all have the same instrumentation in all of the major areas. High-end esoteric testing, however, is concentrated at the University of Minnesota.”

The lab’s mission and vision is as follows:

Mission

Fairview Diagnostic Laboratories supports the Fairview Health System and its partners as a premier integrated laboratory system by providing:

● High quality, accessible, cost-effective, comprehensive services

● Innovative clinical laboratory practice

● Educational resources for its healthcare practitioners

● Accessible diagnostic information in response to customer needs

Recognized regionally and nationally, the laboratory offers a full range of testing capabilities from acute care support to unique reference diagnostic testing, with strong employee engagement, quality, accuracy, and timeliness.

Vision

Fairview laboratories, a team of caring professionals that leads the way in quality and innovation and provides nationally recognized services. We have the best Team, Expertise, Service, and Technology (TEST).

“The key of our mission is supporting the Fairview Health System and making sure that we provide quality service for our patients. And because we have the university, we do research and it’s a major area where we are looking at innovative ways to do things,” Cherry notes.

The lab performs approximately 12 million billable tests a year, does more than 203,000 anatomi c a nd cytology cases annually, employs about 51 pathologists and 950 employees, and has total operating revenue of $552 million.

Figure 1 illustrates the organizational chart for the lab.

See Figure 1 in Attached PDF

Figure 2 illustrates the LIS applications and communications lines for the lab system at Fairview.

See Figure 2 in Attached PDF

Figure 3 illustrates the competitive breakdown in the Minnesota market.

“In our market, Mayo is by far the largest competitor—although I’m not sure if I really view them as a competitor. There’s also Allina Hospitals & Clinics, and we are sometimes neck and neck with them. While Allina is a little bit larger than we are, we are still the fourth largest lab in the state of Minnesota.” Cherry says.

See Figure 3 in Attached PDF

Pros and Cons of the Existing Outreach Program

“We have more than 400 clients, and over the last year and a half, the program has really been stagnant. We haven’t grown, we’ve lost a few clients, and we’ve actually gained a few clients in spite of ourselves,” says Cherry. “However, this is something we really want to continue to look at. We have a full range of testing, including approximately 149,000 tests that are part of the Fairview outreach program. Fairview Laboratory also does all of the testing for the UMP outreach program, which includes over 300 more clients. The UMP segment of our business is about 275,000 tests, which is about $4.2 million in net revenues. In addition, we have direct-access testing in Minnesota so patients can come in and order laboratory tests on themselves. We offer web-based ordering and result reporting to larger clients via Atlas. The lab’s staff includes a director of sales and marketing, two sales and marketing staff, one technical support person (primarily for Atlas), and four client services staff,” Cherry outlines.

“On paper, the structure of the lab looked pretty good. However, we needed to look at what was going on and see what we had going for us that was good. We did have dedicated resources for sales. I didn’t have to pull someone off the bench or have a manager or director actually going out there working as a salesperson and then coming back and b eing the director. We had a director position in place, although it was vacant. I had billing support—while we had dedicated billing people, they were within the hospital billing department. That’s probably not the best place to put your billing, and it should be separate—dedicated billing is essential.”

Fairview also had a central processing area and a customer service department. “However, while we had a dedicated customer service department, I wasn’t sure whether they had the skills or tools to function as they should. We also had a ‘functional’ courier service, which is currently outsourced. That’s something on my mind—whether this is the best thing. The courier is your face to the customers when they walk into a clinic. So when they walk into our clinic, they don’t have a Fairview logo on th eir shirt. They are picking up for lots of other folks so they really are not our couriers. It’s just a contract, and it is functioning. We are not having any trouble with lost specimens, for example, but I am losing the connection with the client because the couriers are not our employees.”

Cherry notes that they also had an online guide so clients could see what testing they offered. “We also had an enormous depth of testing services. Because we have a university setting, we do a lot of esoteric tests, we send out very few tests, and we are able to do a lot of molecular testing. We have a huge molecular department, and we have the instrumentation and the capacity for the testing. We also had a pretty good payer mix, with 58 percent b eing from insurance. At this point, only 11 percent is Medicare. We didn’t depend a lot on Medicare or Medicaid.

“Finally, with seven hospitals involved in testing, we are able to direct the testing to the closest hospital to the client so that they can get the fastest turnaround services. We offer a full range of testing, with molecular b eing the fastest growing area and probably where we have the most outreach contact. In an academic setting, we also can offer consultative services that a lot of laboratories may not be able to,” she notes.

Collectively, the hospitals offer the following types of testing:

● General laboratory testing

● Anatomic pathology

● Cytopathology

● Cytogenetics services

● Flow cytometry

● Molecular diagnostics

● Prot ei n and endocrine testing

● Immunology/HLA Testing

● Hematopathology/Bone Marrow

“As far as what was going against us, the manager/director position had been vacant for a year. “No one had done anything about the job, and I had a group of people [working] on autopilot. They were sometimes doing th eir thing, sometimes not. However, what was working against us was we didn’t have a business plan in place. I had personnel that were part of a salesforce, but they were not truly salespeople. You can’t have techs that you pull out of the laboratory who may not have the psyche to be true salespeople. They need to have the attitude and fortitude to keep going back to the same office, for example. It’s about having the right people in the right job.”

According to Cherry, the lab also had issues with spotty billing. “No one was working the accounts, and we had outstanding accounts rec eivable that were creeping up to 100 and 120 days. We actually now have it down to 53 days. In a couple of months, we’ve been able to move our accounts rec eivable down by paying attention to what is going on.”

Admittedly, she says, the lab had bad customer service, as well. “We had people who weren’t very nice and had no energy when they answered the phones; there was a lack of training. I actually had a person who was working with the computer system, had never been sent to training formally, and was going out to work with clients to get them set up with Web connectivity. This [lack of formal training] does not work at all.”

In addition, there was poor communication among the hospitals. “We have seven different hospitals that were all participating in outreach with clients with specific issues.

We have a module on our [computer] system that, while not as robust as we would like it to be, does allow us to track clients and the issues that they have in a central location. We also have an academic mindset that, although it allows us to offer consultative services, there is a lot of politics involved. Getting academic physicians to have a really good conversation with clients can be difficult because priorities pull them [in different directions]. Again, it’s a positive, but on the other hand it can be a negative. It’s something that I need to learn to manage so we can best use them in our outreach business.”

Outreach on the Rebound

“Our outreach program is now on the rebound. We have a new director, and I would advise that if you are looking for someone to head up your program, that you find someone who knows outreach—i.e., who understands the importance of client services and billing appropriately. That underscores the importance of having the right people in the right job,” Cherry comments.

Fairview Laboratory also has a new attitude. “We’re trying to get people to think differently about how they work with clients and how they work with each other. We also have a new workable business plan. We actually have a direction, which is key and crucial to getting out there. We also are reaching out and identifying who we are going to be working within the marketplace and trying to understand who’s out there in the marketplace to go forward with. In addition, we have a new marketing strategy. We actually have an advantage of having a group of physicians that are strongly affiliated with Fairview whom we have never really gone after as clients. They send 80 to 90 percent of th eir patients to Fairview although we have never marketed to them.”

Cherry notes that the lab has a new mantra: Easy to do business with. “We were not easy to do business with, so we are trying to figure out ways to make things easier. It is complicated for our patients. When you have multiple hospitals and patients going across the system, you can’t have them repeating processes from spot to spot,” she says.

Cherry has also put a new sales force in place of skilled sales professionals. To redesign the sales force, Cherry wrote new job descriptions with direction from human resources. “We are also putting in an incentivized salary program. We need people who are going to go out there and work hard for us. We are also going to align ourselves strategically with other Fairview entities to leverage marketing resources. We have a very large marketing department and several marketing entities that sell purchasing or pharmacy services, for instance. However, they weren’t mentioning that we also have a laboratory outreach program. We are making sure that we align ourselves with the marketing people so as not to r einvent the wheel. We have excellent branding material.”

Another area that needed to get back on track was billing. “I have a Six Sigma project looking at billing redesign, because if you don’t get your money, you can’t continue to operate,” she asserts. Reports are also important, as are benchmarks. “Everybody should pay attention or watch what is going on with to your business.”

Cherry also redesigned the registration process. “Our registration process was different from hospital to hospital, and it wasn’t easy for people to do. Again, this goes back to not b eing easy to do business with. We are also looking at our online guide to redesign it to make it as easy as possible to navigate.”

In essence, Fairview Lab is trying to simplify things. “This is a challenge when you have seven hospitals with as many people as we have in our system all doing things a slightly different way. What we are moving toward is what we refer to as our BHAG: big, hairy, audacious goal. We’re trying to be friendly, easy people to do business with. Our BHAG is out with all commercial laboratories. That’s not to say that we want to push everybody out of business. We have an excellent partner in ARUP, but they don’t compete with us in the outreach arena. However, we do have Quest and Lab Corp that compete with us in outreach. Our BHAG includes having world-class customer service and a sales staff that is attuned to the marketplace, ahead of the curve, knows the community, and is enthusiastic.”

Fairview is achieving its BHAG by b eing easy to do business with, b eing part of the community, and by providing connectivity solutions. “We have the tools to connect to physician offices and th eir EMRs [electronic medical records]. We actually have all the tools in place. We have made the investments to be able to work with our customers and clients, but we’re not using them to our advantage. We need to learn how to connect to an EMR in a very short period of time. Instead of 90 days, we need to learn to connect with them in 30 or 45 days,” she explains.

In addition, we are providing one-stop shopping, b eing friendlier, b eing customer-focused, and providing seamless and convenient choices. “We are currently planning a new central laboratory, and we are going to move our esoteric tests, micro and histology services, which make sense to consolidate. We will have a true area for our outreach so we have a place to centralize some of the things [processes] and move away from the discombobulation [that exists] from facility to facility.”

Finding Inspiration

“On Aug. 1, 2007, the unthinkable happened. We had a horrible tragedy occur when a major bridge collapsed into the Mississippi River. However, while I was watching all of these events unfold, I saw people running to the disaster to help, not running away. I saw a resolve, a commitment, and a spirit of the people in Minneapolis, which inspired me. Within weeks—not months—they created a design for a new bridge that would be solid. Again, this was an inspiration. Sometimes you feel overwhelmed with all of the different issues that are involved in outreach. And while building an outreach program doesn’t compare to a bridge, I was resolved to work at it, to get the right people in to help me, to continue to move forward, and to rebuild and reconstruct the program. It’s interesting watching the bridge b eing built; it’s b eing built in sections. By July, it was scheduled to be connected all the way across. It’s similar as I work on billing, sales, etc. We’re going to reconnect [the sections] and get our program back on track,” Cherry concludes.