How UCSF Health is Leveraging the Advanced Practice Provider Care Model

In this episode of the AHA Associate Podcast Series, Inga Lennes, MD, Medical Oncologist, president of the UCSF Faculty Practice Organization, and senior vice president of Ambulatory Services at UCSF Health, and Guidehouse Partner Ed Abraham, MD share insights on how UCSF is leveraging advanced practice providers across specialties as part of a system-wide care model redesign initiative.

Listen to the Podcast

Bridging the gap

Healthcare organizations face significant workforce shortages across roles, but the impact is especially felt within clinical roles, which require significant expertise and longer training. As healthcare organizations seek to reduce care delays and improve patient access, they’re deploying advanced practice providers (APPs) such as PAs and nurse practitioners, who can fill physician gaps and provide cost-effective care.

For some time, UCSF had been exploring how to best use its APP workforce within ambulatory settings and ensure that APPs were working at the top of their license. Leaders partnered with Guidehouse to re-envision their workforce model, design new and innovative workflows, and identify opportunities to better train APPs to solve access issues.

Redesigning team-based care with skillsets in mind

Prior to the health system’s partnership with Guidehouse, some APPs at UCSF Health were doing work that could be performed by registered nurse (RN) or administrative team members, Lennes said. The health system worked with Guidehouse to examine all roles and responsibilities, and redesign team structure so that APPs are utilized in accordance with their training.

"The goal here has been to ensure that everyone is practicing at the top of their skillset—that the APP members of the care team are utilized in the best way possible,” Abraham said. “This has opened up slots for patients and improved productivity."

With more APPs focused on clinical priorities, workflows were created to direct new patients to schedule with APPs for intake or initial evaluation. Guidehouse and UCSF also worked together to integrate APPs into follow-up care, enabling more consistent and timely care management.

"In some cases, it meant changing the way that our APPs were working with our physicians rather than sitting with them for each ambulatory visit,” Lennes said “It meant creating new templates so that they would be seeing patients independently."

As a result, scribe services—powered by AI—were added to some APP visits to support independent clinical care. The partnership also introduced productivity measurement for APPs, maximizing efforts to use their clinical training.  "This was a total team redesign to make sure that the work that everyone was doing was appropriate to their training and to the top of their licensure," Lennes said.

Lennes and Abraham both noted that aligning staff with the changes and socializing the project was a critical component to its success.

"Communication has been a huge component of this effort because it's change management," Abraham said. "It's moving from established modes of practice into somewhat different modes of practice that are focused on opening up clinics, improving care for patients, improving throughput, and serving both the patient community and the UCSF healthcare community of team members."

Tailoring interventions for each practice

It was also important for Guidehouse and UCSF to consider differences in clinic workflows that could impact the new workflows.  

"I like to say that if you've seen one ambulatory clinic, you've seen one ambulatory clinic, as there's a lot of bespoke design depending on the practice type—and also the discipline," Lennes said. "The Guidehouse team helped us to design those tailored interventions to get us to the goal in each of the practices that we worked in."

The improvements reduced new appointment wait times by as much as two days at clinics with wait times that range from 14-21 days. "A two-day change in our appointment lag is tremendous, and that's just by better templating our APPs schedules to be able to open up appointments," Lennes said, noting that patient satisfaction has also improved at UCSF clinics utilizing APPs, with patients applauding the enhanced access to providers for urgent care and follow-up.

The changes also provide UCSF with an opportunity to collect more revenue across its clinics as facilities serve more patients and more APPs serve in a billable capacity. That’s helping the health system codify the work being done in its clinics and better recoup the costs of care.

Lessons learned from the UCSF-Guidehouse partnership

Abraham and Lennes concluded the podcast with several recommendations for health organizations looking to better deploy their APPs:

• Invest in education: Training may be needed for your entire team to introduce the team-based care model and the role of the APP. Investment may be required in specific roles like RNs to align them with new responsibilities.
• Implement technology and automation: AI and other digital tools can help APPs work efficiently and make change easier for all employees.
• Add APP leaders to your leadership team: Engage APPs in leadership positions to gain from their perspective and build infrastructure to main these kinds of changes in the future.
• Focus on change management and emphasize the "why": Consider how improvements may disrupt existing workflows, align employees with change and explain to them how changes improve patient outcomes and experience.