LEDI Delena Brockmann | Outpatient Care Integration

Every health system leader has unprecedented executive management challenges facing their organization in the wake of the pandemic. One area that has particularly grown since is outpatient care, which comes with unique sets of challenges. In this episode, we take a deeper look into outpatient care under the umbrella of systemness. We are joined by Delena Cook Brockmann, the Executive Director of Operations at Piedmont Athens Regional, to share how they strategically align outpatient care with the rest of their system. She shares the Oconee Health Campus, the huge impact it made on patient experience and the community, and the growth they’ve seen since. Delena then gives the top recommendations on successful outpatient integration while unpacking the pitfalls you need to avoid. The health system is ever-changing, ad as leaders, we need to stay on top of it. Tune in to this conversation for more insights.

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Oconee Health Campus: A Model Of Successful Outpatient Care Integration With Delena Brockmann

Welcome everybody to another episode, brought to you by the Baldridge Foundation and our sponsor, ABOUT Healthcare. We have our usual cast of characters with us. Darin Vercillo and Ben Sawyer, both from ABOUT Healthcare. As you all know, Darin is the Chief Medical Officer and Ben is the jack of all trades. He does almost everything that ABOUT Healthcare does. He has a lot of responsibilities there. It’s great to be with you guys. We have another great episode scheduled where we’re going to be talking about outpatient care.

We’ve alluded to this topic a number of times in the past. We wanted to take a little bit of a different angle and talk about outpatient care under the umbrella of systemness. It’s pretty obvious. I’m sure this is the way it is in many of your organizations that so much care is moving to the outpatient side and there are a lot of challenges associated with that. Access and quality challenges still exist in all phases of care but there’s also a big component of the financial challenge here.

As a number of procedures that used to be done only on the inpatient side with high remuneration are moving over to the outpatient side. Joint replacement’s probably the best example of that I can think of. It’s important to figure out a way to integrate your outpatient care experience with what you’re doing on the inpatient side.

We have a great guest to discuss that with you. Her name is Delena Cook Brockmann. Delena is the Executive Director of Operations at Piedmont Athens Regional in Athens, Georgia. Piedmont Athens, as you may recall, since we’ve talked about that organization before, is the second largest hospital in the Piedmont Healthcare System. Piedmont Healthcare is the largest health system within the state of Georgia, with well over 3000, almost 4,000 physicians, thousands of employees and multiple sites all around the state.

Delena serves as the Piedmont Athens Regional Executive Leadership team member with oversight of overall outpatient campuses, outpatient residency clinics and outpatient cancer programming. She developed strategies for market expansion and growth opportunities. She’s also responsible for the creation of Piedmont Healthcare’s first multi-service line, outpatient and ambulatory campus, the Oconee Health Campus and the Orthopedic Sports Medicine campus, which included the design, construction and operation of the facility.

I’m very familiar with that campus since Delena and I were the ones that put it together and built it. Delena’s been running it ever since its inception. I can tell you that it’s made a huge impact on the community and it’s also had a huge positive impact on the organization. Delena, it’s great to have you here and see you. Welcome.

Thank you so much, Dr. Peck. It’s so exciting to be here and talk about a passion of mine.

Let’s start by having you talk a little about how outpatient care at Piedmont in general has been strategically aligned with the rest of the system. Specifically, maybe talk a little bit about the opening of the Oconee Health Campus. When you opened that campus a few years ago, there were some things that most people had not been doing that you incorporated into the opening and were very focused on the patient experience and how the facility has grown so quickly to become an integral part of the overall Piedmont Athens system strategy.

I love talking about how the Oconee Health Campus was created and how it played such an active part in helping Piedmont Athens Regional overall. I remember when this fellow, Dr. Peck, asked me if I wanted to go build Oconee and I had no idea what he was talking about but I said yes. I want to encourage leaders to say yes when they’re asked to take on a project.

We were trying to find a way, as most hospitals are, to decrease the traffic around the hospital that didn’t need to be there. There are all these services that maybe don’t need to be on your hospital campus and we were trying to strategize what could be moved away. We were lucky, fortunate, whatever you want to call it, to make sure that we built Oconee as a retail destination where we knew that people were going to commute. That’s a very important point.

Thinking about Piedmont though and making this a system, this was right before Athens joined Piedmont but we were already part of the strategic plan for Piedmont from quality, safety and service, stewardship, talent and then strategic growth. As we were looking at what services could move away from the main hospital campus, I remember us thinking that we might need about a 50,000-square-foot facility.

After talking to the community, which is an integral piece of being successful in this, talking to our clinicians and our providers and assessing what the needs were, we came back to the board and asked for a 100,000-square-foot facility. I’m so thankful that they said yes. We wanted to make sure that patients could come to a place that was a one-stop health shop. What many services could they receive under one roof that not only provided that access, which we talk about in healthcare all the time, accessibility?

Our campus not only provided access but more importantly, great patient care and then feedback to the hospital. That’s part of our strategic growth and stewardship. We use the Oconee Health Campus not only to deliver great care out in our community, closer to people’s homes but then also for higher-acuity healthcare, they know where to go for that. That’s a little bit about how the Oconee Health Campus has played a role, not only for Piedmont Athens Regional but even Piedmont Healthcare being the largest outpatient campus that we have.

Could you talk about a few of the things that you put into the campus that, at least at the time, most people had not thought about that made a huge impact on the patient experience and caused a buzz in the community that allowed for the growth that you’ve seen?

There were a couple of things. First, it honestly is easy to build a beautiful building. However, marrying the patient experience with technology was probably key for us. One thing that we did is we hired a patient experience coordinator who would greet and welcome everybody as soon as they come in the door. These are very simple things to do but often we overlook them or think, “That might not have a return,” but I would beg to differ. It has a significant return when you’re treating people well. Hiring this employee, her name is America and she’s still with us. America makes everyone feel at home as soon as people walk in the door.

Most people are very nervous about coming to the doctor. Many of them have anxieties and fears. Those always calm down as soon as America interacts. You then have to marry technology with this, not so much technology that it intimidates people but that it accentuates the visit. One thing that we implemented was a system that allowed a few digits of the telephone number to show on a television screen, essentially and it would show you your wait time.

We de-identified the patient by only showing a few digits of the patient’s phone number but the patient was able to see where they were. I am a very impatient patient so I feel like I’ve waited half an hour. I only waited four minutes. We’re putting that in perspective. That system also allowed for our employees to know how long the patient has been waiting.

To me, there’s an emphasis on making sure that we’re moving and taking care of things. This system allowed people to essentially use their phone and a QR code to check in, no more writing a name down on a notebook or we’re putting it on a binder and then able to see where am I in the queue. We implemented that in every department that we had. It was something that was familiar for patients from when they went to their primary care doctor down to rehab, over to imaging and the lab. You’re creating this sense of oneness on our campus. It was pretty cool.

Could you talk a little bit more? I’m then going to let Darin and Ben jump in here. Could you finish off by talking a little bit about Oconee? What service lines and other things did you put into Oconee that you found out that the community wanted? Also, how has the Oconee campus grown? Talk a little bit about your move into orthopedics and what that meant.

This is my favorite topic. I often sing Head, Shoulders, Knees and Toes when I’m trying to strategize what services need to go in our building because we overcomplicate everything in healthcare. We overcomplicate checking in, the visit at times and the billing. My purpose is to uncomplicate that and give people a one-of-a-kind, hassle-free experience where they can be in one place to receive many different services.

We overcomplicate everything in healthcare. Share on X

The service that we decided to include in the Oconee Health Campus is primary care, making sure that people had that first entry door into taking care of their health. When you see your primary care physician, they may order tests so you can walk straight downstairs and get your labs drawn with no appointment. It’s hassle-free. We included advanced imaging so MRI, CT, ultrasound and X-ray. We have a pharmacy. If there are any medications that are prescribed, the patient can go down and pick those up. We all often tease about their only being 24 hours a day so we want to maximize the visit while the patient is here.

We also included specialty services, cardiology, gastro and women’s services. We all know that many moms and wives make a lot of the healthcare decisions in the home. We wanted to give our moms, wives and women an experience that they would not forget so that when they were deciding on healthcare services for their entire family, we would be the person to pick. We included outpatient rehab. That includes ortho, neuro, speech therapy and pediatric therapy. We include cardiac rehab and then urgent care because the primary care’s not open all the time. Should there be additional labs or radiology needed, that’s there and then the pharmacy as well.

LEDI Delena Brockmann | Outpatient Care Integration
Outpatient Care Integration: We all know that many moms and wives make a lot of the healthcare decisions in the home. We wanted to give them an experience they would not forget so that when they were deciding on healthcare services for their entire family, we would be the person to pick.

One thing that we did that some might think, “Why in the world did you all do that,” we included a very large conference room area that our community can use. It can seat up to 100 people. It is used by all of Piedmont for system training and our community. Combining our services with the community so that we are partners in healthcare has been a tremendous success for us. We got our women’s center and mammography, GI and transplant. Transplant surgery is done in Atlanta. Our patients come to the Oconee Health Campus for their pre-op visits and post-op. We’re making it easier for people.

A few years goes by, we decided to add our second building, which Dr. Peck alluded to, our Orthopedic Sports Medicine facility. It’s incredible. We have sports medicine, rehab on one side and then all of your orthopedic surgeons and physicians on the other side. We are so thankful to be the healthcare provider for the UGA Athletic Association and we tout that loudly. It’s exciting to take care of athletes, weekend warriors and folks who are trying to get out and be active. That facility is also on our campus. We have a third building going up. Details are to come soon so that we encompass the entire campus as a place where patients can go. It’s so awesome.

Delena, congratulations. It’s not surprising that you’ve been successful at this level. I want to ask a question from our readers’ standpoint. Increasingly after the pandemic, outpatient has become a battleground for competitive forces. You have a lot of non-traditional entities coming in like Walmart, Amazon and CVS. A couple of questions in that regard. How critical was what you have put in place for Piedmont Athens Regional to essentially blunt that competitive thrust? How important strategically for health system leaders, as they’re reading this conversation, is it that they pay attention to systemness from the standpoint of the integration of outpatient services?

When you think about it, Amazon and Walmart make healthcare easy. It’s convenient. We have to make sure that we’re offering something competitive. It’s got to be convenient but it goes further than that. If I’m going to get my sore throat checked on, so be it but what if there’s something more? To me, it behooves leaders to make sure that they’re offering facilities like the Oconee Health Campus so that patients can begin to develop a relationship. Healthcare is more than a one-and-done. There are times and illnesses that we have that we get treated for and then we’re out of there.

Overall, our healthcare needs to become a relationship. What Piedmont has done very well is put several of these campuses out in communities closer to people’s homes involved in the community. It’s not just someone showing up and offering a service but these are people who live and work in the community. Now that relationship is formed. When you need higher acuity care, you automatically know where you’re going to go because the outpatient campuses are the feeder to the larger hospital system.

That’s a great response. Darin, I’ll flip to you and I have a couple of other follow-up questions.

Delena, this is great. Your energy is infectious and all the things that you’re doing are fantastic. I want to hone in on a particular area. Chuck mentioned at the beginning about systemness. You’ve talked about that yourself. Piedmont’s a big organization. You have the outpatient side and the inpatient side. You have surgical centers and services that are being offered.

I dare say that the whole organization is grown probably organically and inorganically as you’ve added resources into the area. At ABOUT Healthcare, we work across the country, especially on the transfer center side and the side of bringing business into the hospitals. You’ve mentioned something that I wanted to key in on. You’ve talked about the outpatient centers being a feedback and growth mechanism for your hospital organizations.

This is a key thing that we hear from many of our readers and many of the people we speak with. What I want to ask you is this. As you’re growing these outpatient centers, center 1, campus 2, campus 3 and you’re adding in things like ortho and cardiology, you’ve got primary care doctors referring patients over saying, “You need a hip replacement, a cardiologist, this, that or the other thing,” how are you encouraging, assuring and making sure that you are referring the patients over to your specialists so they leverage that?

How are you ensuring that your specialists are responsive and not saying, “You can have an appointment in twelve months?” You lose people somewhere else and they take their business to another hospital. How do you connect that referring access to the accepting doctors that come into your hospital for that growth mechanism that you talked about?

Overall, we want our clinicians to refer to whom they think will provide the best care. Thankfully, at Piedmont, I feel like we hire incredible physicians. That’s an easy referral to make. We also have what’s called our Piedmont Clinic. We have employed physicians as well as physicians who are out in the community and who are part of that clinically integrated network. Being part of that adds to the Piedmont family. It makes the Piedmont family larger. There are certain requirements and incentives within that program.

The other thing is telling our story. You don’t want to refer to a physician you can’t be seen for a year. That behooves leaders to be paying attention to those referral patterns. If people are waiting a year, we need to be working with physician recruitment to get another specialist. Leaders have to stay in front of that, not behind it, because once you lose the patient, you’ve probably lost the patient.

We saw that with rheumatology. I’m getting ready to open our first employed rheumatology practice and we’re so excited because the wait time is a year in our community. As leaders in healthcare, we have to be paying attention to what those volumes look like and stay ahead of it so that there is always an open door for our primary care doctors and other physicians to be able to refer. We got to stay ahead of it for sure but the quality speaks. If you go see a great doctor, not only is that going to build your brand out in the community. That good news is going to spread back to the physician, “Thank you for referring me to Dr. So-and-so.” Developing those relationships strengthens those referral patterns.

LEDI Delena Brockmann | Outpatient Care Integration
Outpatient Care Integration: As leaders in healthcare, we have to be paying attention to what those volumes look like and stay ahead of it so that there is always an open door for our primary care doctors and our other physicians to be able to refer.

Do you have a particular threshold that you look at and say, “If these referrals are going out more than 30 days or 90 days,” or does it depend on the particular subspecialty area availability?

It depends but we do look at that. We monitor how long it’s taking people to get in. For us at Piedmont Athens, Michael Burnett, our CEO leads a weekly strategic meeting about this recruitment. We call him the Dr. Whisperer because I believe he’s brought over 25 physicians in the last few years. If you think about what has been going on in the last few years to grow 25 physicians over the time of the pandemic is huge. Studying that allows leaders to determine, “What other specialties do we need to bring in? Does this doctor need a partner?” We’re already looking for a partner for a rheumatologist who opens so got to stay ahead of it.

Delena, remember that I was a rheumatologist.

I’m not open for business but there you go.

Send me your resume, Dr. Peck. I’ll take a look at it.

Delena, I wanted to ask this question from the reader’s standpoint because what we’re hearing is superlatives, super positive things but I know that there were also some real challenges. If you’re providing recommendations to others that are thinking about doing the kinds of things that you’re doing, what are the top 2 or 3 things that you would give them? Make sure you’re addressing this because otherwise, it’s a real pitfall or problem.

It’s not always a walk in the park. Most days, I would say it is and it’s worth it. A couple of things that you have to consider as a leader. If you were going to build an Oconee in your hometown or somewhere to retail destination near one of your hospitals, are you going to build it or is someone else going to build it? Who is going to upfront the amount of capital that it is going to take to build one of these? You have a couple of different options. If you are flowing in capital and want to build it yourself, go for it. Some people decide to allow a developer to build and then lease that back. That’s less money for a hospital system.

Money is something that everyone has to consider. You have to weigh out the pros and cons of each. Another thing to consider is reimbursement and your payers. That was a headache for Dr. Peck and me as we were considering moving away from the campus. As you all know, when you move away from the campus, you’re moving away from hospital reimbursement. That is something to consider.

When you move away from the campus, you're moving away from hospital reimbursement. Share on X

As Dr. Peck always reminded us, 50% of something is better than 100% of nothing. It’s part of your strategy to determine, “Are we willing to take a haircut on some of this to get other benefits going down the road?” When you think about Oconee, we have over 2,000 people a day coming in our doors. Doing the ratio of 2,000 people, there is a percentage of those people who are going to need higher acuity care and that are going to come back. You have to weigh all of that out, pros and cons.

The next thing is a little softer. These are my favorite kinds of things to talk about but it’s getting everybody aligned with the vision. Building a building and putting services in the building is not enough to be successful. It may sound simple and I hope people don’t take it that way. I hope people dive in and dig in that if you are going to build an Oconee Health Campus in your neck of the woods, you have got to get everyone on the same vision because it has to work like the body system does, together. It has to ebb and flow.

It can’t be a bunch of different services in a building. That is so yesterday and so not where you will get your strategic benefit. You have got to operate as a system not only within the building but back to the hospital. I love to call Piedmont Healthcare the mothership, back to the mothership. It’s all got to work together. That’s hard. If you think about practices, they’ve been off in their one little building or little suite and they have operated independently. We need to operate as a system. That’s something to take into consideration.

Great recommendations. Thanks. Back to you, Chuck.

I have a couple of comments. There are a couple of important things that aren’t necessarily directly related to outpatient care or systemness but are very important. Delena has mentioned a couple of them. I wanted to say a little bit more. Having a strong outpatient presence makes having a clinically integrated network a real plus if you don’t already have one or if you can make yours stronger.

If it’s what I call a hybrid network, it’s even better. Having a clinically integrated network that not only includes employed physicians but also has a substantial number of community-based physicians in it where the incentives may be a little bit different but there are a lot of incentives that are not different. They’re the same. It gives the opportunity for physicians who want to be employed to be employed and those who want to remain independent to remain independent.

When it comes to referring, communicating and feeling like you’re part of something so that you’re not competing against but rather working with others, having that a network with a large number of doctors that represent all different areas of medicine is a real plus to have when you’re trying to create systemness across outpatient and inpatient service lines and that thing.

The second thing is something that Delena mentioned, which is also important. You have to figure out what your strategy’s going to be around reimbursement and the differences between inpatient and hospital reimbursement, outpatient and hospital reimbursement or HOPD rates for the same services. We thought about this a lot and had some pretty difficult conversations with the payers as we went about this.

We did a pilot and we focused it on a service that is highly reimbursable but also easy to have in an outpatient area, which is an MRI. The reimbursement for MRI is significantly less than it is if you have it on a hospital campus. That’s going to benefit significantly, potentially the payer. What’s the payer going to do? How are you going to negotiate with the payer?

If you offer significantly lower prices at the MRI and the outpatient campus, what’s the payer going to do to help you take up that slack in some of your top reimbursed areas inside the hospital? Having open lines of communication with your payers, not just at the time of contract negotiations but at other times when they know that you want to be a partner, not an adversary and vice versa does help you when you’re trying to make these difficult decisions around reimbursement rates.

I wanted to point that out to the audience. Those two things are important when you’re thinking about pursuing a strategy like this. Delena, this was terrific. You covered a lot of ground quickly with practical solutions and answers for the audience. Thank you so much. It was great talking with you. Ben, you probably have a couple of things you’d to tell the audience about some upcoming shows and things like that.

Delena, thanks again. It was great to see you.

Thanks all for having me. I appreciate it.

For our readers, there is another interesting webinar coming up on August 24th, 2023. The topic is still being looked at but it is going to be centered probably around care orchestration and how to practically make it happen for our patients and in making sure they get exactly what they need with details to follow.

There will continue to be two episodes every month published on the second and fourth Tuesdays of each month, where we will continue to press into the things that you all are experiencing and want to learn more about. If you have particular topics that you’re interested in, you can put that on the show’s website and the event coordinator, Aaron Sellers will respond and feed that into the team so that we can incorporate your feedback.

Thanks a lot, Ben and Darin. We’ll say thanks again to Delena. Hope you’ll join us for our next episode and then the webinar that Ben was talking about. We’ll continue to try to bring guests on that can offer some practical information that you can hopefully take back to your organization and utilize to help improve your situation and deliver a better experience for your patients. Good day, everybody.

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About Delena Brockmann

LEDI Delena Brockmann | Outpatient Care IntegrationDelena is a highly motivated and resourceful professional with a proven track record of success in the healthcare industry. She currently serves as the Executive Director of Operations at Piedmont Athens Regional Health System. She brings 19 years of experience in healthcare operations and management to her role as Executive Director of Operations.

Prior to assuming her current role, Delena served as the Director of the Oconee Health campus of Piedmont Athens Regional, the first multi-service line outpatient and ambulatory campus. Delena will share her perspective and insights on this important theme and topic, providing practical suggestions that can be applied immediately.

Delena Brockmann holds a Master of Business Administration from Columbia Southern University, serves as part-time faculty at the University of Georgia College of Public Health, and a guest speaker on Informatics to the UGA graduate program. She is also very involved in the Athens and Oconee County communities, serving as Executive Sponsor of the Emerging Leaders program and a facilitator for Leadership Oconee.

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