8. Sustaining and Expanding
Sustaining Your Program
Most staff that have participated in group visits say they want to continue offering them to patients because patients enjoy them and they see the positive impact on patients’ health. It is highly recommended that teams consider plans for sustaining group visits during their planning so that they can increase the likelihood that visits will continue. The following steps are recommended to ensure success:
- Include plans for sustaining group visits at the beginning of your project
- Prepare leadership and team members for barriers to sustaining group visits, so that they can support you when you encounter them
- Focus on continual process improvement especially with recruiting and retaining participants, billing, efficiency of staff time, and teamwork
- Identify goals for future group visits and set timelines
- Inform and educate all staff at the health center so that there is support from the organization
- Work with the person that does outreach or marketing so they can support your efforts
Group visit sustainability often depends on how health centers overcome barriers to patient recruitment and retention. There are several ways to improve patient retention and recruitment in group visit programs. For example, health center staff can make follow-up calls and use incentives to improve retention. Providers can aid recruitment by referring patients to the group visit program.
“Our first diabetes group visit was worthwhile and patients got a lot out of the visits learning from each other. We have followed-up with our current participants via phone and many of them have mentioned that it would be wonderful to start another group again.”
Whether a group visit program will be continued depends on team factors (preparedness, motivation, efficacy, collaboration, satisfaction, etc.) and perceived benefits and barriers. A team with high staff turnover may find it difficult to continue group visits whereas a cohesive, collaborative team that share common project goals are more likely to continue group visits. Support from health center leadership and buy-in from providers and other staff may also have an impact.
We have seen that effective organization and time-management are key factors in the viability of group visit programs. Health centers that were able to effectively manage time when planning and implementing group visits were more likely to continue group visits than health centers who experienced struggles and barriers to time-management.
When planning ahead consider the following questions: What do you want to see with the group visits moving forward? Will you continue with the current cohort of patients? Will you enroll a new group? How do you plan to sustain the group visit program? Do you need to engage more health center staff? Do you plan to obtain more support from senior leadership? Are there any more resources that you can use to sustain change? What improvements can you make to the program?
“Although there are a lot of barriers that we need to address as an organization and within clinics, I think diabetes groups, and potentially other chronic disease groups would be beneficial to help change the model care and help clinical staff, including providers & nurses, be more productive and efficient with their time.”
Billing and Reimbursement
Finances are also important for group visit sustainability. Establishing an effective billing mechanism is crucial. The medical visit portion of the group visit may be reimbursable. Group visit teams and providers may need to consult with billing professionals at the health center to ensure billing is executed correctly and to maximize potential reimbursement.
Key questions to consider include:
- How will your health center’s payors reimburse for group visits?
- Are there any public insurance programs that provide reimbursement for the medical visit?
- Does that reimbursement methodology provide any additional revenue?
- Does the group visit model enhance efficiency or productivity?
- Do the group visits coordinate with other projects that may provide financial incentives for meeting certain clinical metrics?
- What financial measures may the team consider tracking for reporting to senior leadership?
Pitching Success
Sustaining your group visit program is also dependent on how well you pitch the program to others. Pitching success is important for increasing engagement from senior leadership, staff, providers, and patients. It can also help spread the program through word of mouth. Timing and framing the message in an effective way is key to pitching success. This could be done in the beginning of the project to pique interest and in the middle of the project to acknowledge interim successes.
Below are some examples of how to pitch group visit programs to others:
With the changing landscape of healthcare, health centers must be innovative in attracting insured patients and must demonstrate programs centered on population health for continued federal grant support. Group visits address both of these.
Do you have diabetes? Do you want to learn from others with diabetes while also having a chance to meet with your doctor? Group visits may be for you.
It is important to consider how to tailor your message to your audience. The interests of senior leadership, board members, patients, staff, providers, funders and community members differ, and so you may choose to emphasize certain aspects of group visits depending on the audience. For example, you may highlight the community and social support element when explaining the program to patients.
Other questions to consider include: How do you plan to report results and pitch success during group visits and after group visits end? Do you plan on including patient testimonials? What platform is your team planning to use? If the results were not what you expected, how do you plan to use this opportunity to engage in quality improvement?
Expanding to Other Conditions
When choosing how to expand your group visit program to other health conditions, it is important to consider your patient population and the audience you are trying to reach. What other health conditions does this patient population face and can this condition benefit from group visits? In addition to improved health outcomes, participants report better medication adherence, a sense of community, and increased social support.
There has been interest in expanding the group visit model to hypertension, nutrition, heart health, obesity and weight loss, and mental health. Engaging group visit patients in this expansion process is important to ensure that you are tailoring the group visits to meet the needs of your patient population.
“We have the right team for this in place and will continue doing the group visits. We have plans to start a new group visit for diet as well.”
Potential Roadblocks
Your team would like to continue group visits. The clinic director does not want to block off providers' time for group visits each month if attendance is inconsistent. How would you advocate for continuing the program?
- Calculate how many patients a provider would typically see or how much revenue a provider would typically generate in the time that would be dedicated to group visits. How many patients would you need to recruit and retain to match or exceed this? Are there ways to improve recruitment and retention that could help you achieve that number? Present your calculations and proposed strategies for increasing attendance to clinic leadership.
- Think about the current priorities of leadership at your organization. Is your clinic trying to achieve better A1C control, meet preventive care quality measures, improve patient satisfaction, earn a particular designation, or introduce innovative models of care? Highlight positive outcomes you have seen so far from the group visit program and how they align with your organization’s goals.
- Share patient stories about how the program has helped them.
- What else could you try?
Your team wants to expand your program and start group visits for hypertension. Your clinic only has one conference room and other programs and classes need the conference room space as well. How do you convince clinic staff and leadership that group visits are a priority?
- Be creative and think outside the box. Host your group visits at an off-peak time at the clinic. Meet outside if the weather is nice. Go on field trips for some sessions (grocery store, YMCA, etc.). Consider meeting virtually. See if there are other organizations in your community that might have space for a group from your clinic to use (churches, schools, libraries, etc.).
- Survey patients or use existing data to see what the priority issues are. If hypertension is a major concern, use that information to advocate for your program. If other topics are of greater concern to the community, considering waiting on hypertension and starting your next round of group visits with a focus on something else.
- Does one of the other programs have a similar goal or target audience (weight management group, nutrition classes, etc.)? Perhaps you can join forces and incorporate their expertise, activities, and curriculum into the group visit model.
- What else could you try?