Automate busy work and create space for the patient

Solving Staff Shortages and Provider Burnout: A Primary Care Success Story

Bob Girard is the Chief Financial and Operating Officer of Whole Life Health Care, a primary care organization in New Hampshire. Read on to learn how athenahealth supported steady growth, reduced busywork so staff can focus on patients, and enabled more seamless care coordination and AI-assisted documentation.

Q: What makes primary care so important, and what challenges are shaping your organization today?

A: I feel really lucky to be working in primary care, and we’ve been in business for 25 years. The last five years have been particularly challenging. Our challenges 10 years ago were growth and filling the schedule and ushering in new patients. In the last five years, we’ve seen a real squeeze on our staff. We’ve seen a lot of compassion fatigue for our providers. We are drinking from a firehose when it comes to patient demand.

We want to be able to serve everyone in our community. Our biggest challenge right now is that we are constrained by our size. Since going live with athenahealth, we’ve grown anywhere between 9 and 11% every year, very steady on average. Which has been wonderful. If we wanted to grow 30% this year, we probably could, but we just don’t have the room, the staff, the available bandwidth to see all the patients that want to come and see us.

There are a lot more needs for mental health when it comes to our population. We try to make sure we have enough time for our patients. A half-hour visit is our most popular visit. We don’t have a 10-minute visit. We want to make sure that our providers have time with patients to discuss not only their chief complaint of the day, but whatever else is going on.

Q: How do you think about the role of primary care in creating a strong patient experience?

A: We are the gateway for every other service that a patient needs within our community. So, we coordinate care. A patient comes in to see us. We see them for primary care, but if they need anything outside of our practice, we usher them. We introduce them to other practices within the community, specialists, even outside of our state if necessary.

That patient-provider relationship is the cornerstone. It was the vision of our founder to have a collaborative relationship that was not just one visit a year or three visits a year, to have an ongoing relationship for that person’s health for their entire life. We’re not interested in just treating a diagnosis. We look at the entire person. You have to take mental health into consideration. You have to take nutrition into consideration. You have to take not only the problem of the day, but what’s the big picture for this person.

For us as primary care, we get to see generations. We see entire families. We’ve watched kids grow up. So that’s pretty cool.

Q: How has athenahealth helped Whole Life Health Care stay independent and grow?

A: The first month that we went live on athenahealth, this was 12 years ago, it was the best month we’d ever had from going from paper charts to an EMR, which was unexpected. The process was easy for us. I’m thankful that we made the decision to go to athenahealth.

Since then, on average, we’ve grown 9 to 11% every year. We’ve never dipped below nine. That type of growth has been very palatable. We’ve been able to add staff, we’ve been able to add exam rooms, and it hasn’t been a burden. That happened because of athenahealth.

athenahealth has allowed us to automate a lot of busy work. When we signed with athenahealth, I told everybody within the practice that we were hiring athenahealth. I actually wrote a hire letter and said, athenahealth, thanks for checking everybody’s insurance. athenahealth, thanks for making sure that you’re checking those patient balances. Those were all things that were very labor-intensive to us.

We were able to remove a lot of the busy work, important, but maybe we didn’t need to devote a lot of time to it. In athenahealth’s model, we were able to repurpose folks that had been with us for a long time. You’re not going to have to spend time making phone calls or rescheduling appointments. Now you can focus on the person that’s walking in. Now you can focus on what’s the chief complaint of the day. Now you can focus on the new mom that’s walking in, holding a two-year-old’s hand that’s barely walking and carrying a baby in a bucket and having a conversation rather than saying, “Hey, can I get your insurance card?”

The more that we’ve been able to hand to athenahealth to take care of, whether it’s pre-visit check-in or patient history ahead of time, that affords all of us more time to look and speak to the patient and really connect with them, not just usher them into the practice and move on to the next.

Q: Why has athenahealth remained the right long-term fit for your practice?

A: For years, I have said, athenahealth is not a vendor. I have a filing cabinet filled with folders that are vendors to Whole Life Health Care. I consider athenahealth to be a business partner.

I trust our [Customer Success Manager] CSM. I trust the people within athenahealth who I’m referred to when we have a problem. I go to our CSM and the athenahealth team when we have challenges. If our CSM doesn’t have an answer, I will bet on her every day that she will know somebody within the organization that can help me. If she doesn’t know somebody within the athenahealth organization, I know there’s another practice out there in the athenahealth community that has probably had the same challenge, and they might have an answer for me.

The trust that I have with athenahealth after all of this time is valuable. I believe they know who we are as a practice. Our CSM has been really good with making suggestions over the years on how we can optimize our schedule, how we can get more juice with the same squeeze.

I forget that the folks at athenahealth don’t work in health care. I forget that they’re a software company. I would say everybody on our team probably feels the same way.

Q: How has athenahealth supported more seamless coordination and referrals for patients?

A: We have a staff of folks who specialize in referrals. We actually have a person on staff that is a liaison to all of the other medical offices in our community that help get our patients in. Our experience as primary care is where we’re seeing more delays when it comes to getting patients into a specialist that they might need to see. So rather than just sit back, we make phone calls. We do it the old-fashioned way. We really rely on our relationships with other providers, with other offices. We work really hard to advocate for our patients.

If we have a patient that comes in for their annual physical and the topic of mental health comes up and if they’re struggling, it’s not uncommon for our provider to document that in the visit. In some cases, they can make some recommendations to the patient within the exam room and have a follow-up appointment. But we can also, with that documentation, in our building, we have mental health counselors that we can refer to. Because it’s documented in athenahealth, because they might need a referral, that gets documented, it gets sent to our staff, the appointment gets made, and then that patient might be back a day or two later to see a mental health counselor.

Totally seamless. All of that information from the visit is then shared with the mental health provider that they’re being scheduled with.

We work with a lot of different offices within our community and outside of our state. Being able to take the content of an encounter or a patient’s chart, share that with another office, and provide that coordination of care as quickly as we possibly can — we’ve undoubtedly been able to remove the delay in care that existed before, when we were faxing information, when we were mailing information, when we were printing information. We can send it right after the visit. Typically, a referral in our office is done within 24 hours as opposed to 3 to 5 days.

To be able to tell a patient, this is the course of action I see for you, this is the appointment that I’m going to recommend, and we’re going to take care of that for you, as opposed to handing it back to the patient and just letting them loose — we want to be full service. athenahealth allows us to be. They really facilitate our ability to share information with other offices and truly take care of our patient.

Q: How are you thinking about AI in healthcare, and what impact are you already seeing?

A: I’m very curious about AI, because we are using it a little bit that we know of. We have a provider that is using Suki AI to generate encounter notes, and it’s been helpful. It’s been very helpful to them as a practice.

We are working really hard to not over-automate health care. We do not practice corporate medicine. That was a reason why we chose athenahealth. As we were looking at larger systems that required a computer on wheels, that put a barrier between the provider and the patient, athenahealth was very configurable for us.

Even to this day, we have some providers that still don’t take a computer or a laptop or a tablet into the exam room. Working within athenahealth, we were able to remove the perceived barrier of a computer being between the patient and the provider. So really, athenahealth allows us to keep as much of the humanity in health care without over-automating.

One of our nurse practitioners who was really struggling with her documentation, she came to me and said, “I don’t know how you knew I needed this, but I needed this.”

Q: What results are you most proud of with athenahealth?

A: I’m really proud of our business performance. We have been able to reduce our no-show rate to the point where it’s less than a percentage. It’s a fraction of a percentage point. Our no-show rate wasn’t bad, but it’s stellar now.

I also like seeing that we are truly optimizing our schedule. It’s easy to take a look at our schedule and know that we’ve planned for the next two years, and that we’re not going to be rescheduling patients due to vacation time or unforeseen absences. We have a method in place. We can look forward in the schedule with athenahealth as we’re building it for the next year or next two years, and know that we’re going to be able to accommodate our patients and growth.