Executive Summary
Truly achieving the right level, right place, and right time of care requires significant changes to the way health systems operate. Systems must challenge long-held assumptions to redesign the encounters, decisions, and pathways that govern how patients move through the system. This article examines how leading health systems are redesigning care models, centralizing decisions, and smoothing throughput so that patients receive the right care sooner and with more consistency. This article distills lessons from three systems who have upended the traditional way of thinking about what constitutes the "right" level, place, and time:
Cleveland Clinic is expanding capacity by redesigning the visit itself. Shared Medical Appointments (SMAs) blend virtual and group care to increase clinical touch, reduce wait times by nearly 50 percent, and add 6-8 extra patients per provider for each SMA conducted compared to one-to-one appointments conducted in a 90 minute period.
Inova Health is revealing hidden capacity by centralizing transfer decisions, bed placement, and referral routing. Their coordinated operating model has reduced placement times, increased transfer acceptance, and opened up flow across sites.
Emory Healthcare is demonstrating that care can happen far sooner than expected. Their access sprint showed that earlier appointments are achievable when expectations are redesigned and variation is removed from daily operations.
Key Insights
What if the right level of care is shared?
What if the right place of care is revealed through centralization?
What if the right time of care is earlier than you think is possible?
Part III – How do we actually achieve delivering care at the right level, right place, and right time?
Right level, right place, right time of care has long been a guiding mantra for access, yet many systems still struggle to achieve it in practice. Access can break down not only at the point of entry but also in how patients move through the system. Getting the right care at the right level, place, and time is challenging because mismatches persist. Why? Because the underlying structures have not been reenvisioned or redesigned for today’s demand. Leading systems think differently about what “right” means, enabling them to advance towards this goal.
Insight 1: What if the right level of care is shared?
Health systems often address access challenges through staffing. If physicians are stretched thin, the instinct is to shift more routine work to APPs or nurses, automate simpler tasks, and reserve physician time for “top-of-license” care. These strategies matter, but they only solve part of the problem.
Access bottlenecks may persist not because of a mismatch in provider type for the level of care needed, but because the visit format itself has not changed. Some care cannot be shifted to different provider types without weakening continuity or clinical confidence. Patients may still want to see their physician for routine management, reassurance, and nuanced decision-making. However, traditional visit models limit that because they are built on a scarcity mindset.
Systems often try to address this in one of two ways:
When each patient must be seen individually for every appointment type, expanding access means expanding rooms, staffing, or hours.
The Problem: Chronic disease populations are growing faster than any of those inputs can scale.
To see more patients in the same rooms with the same staffing and hours, expanding access means making appointments shorter.
The Problem: Patients might wait weeks for appointments with their physicians that are too short to meaningfully address their conditions or to feel engaged in their care.
The question then becomes: is the “right level of care” truly about the right encounter-type with their provider? For many patients, the right level is not a shorter visit or a different type of clinician. It is a redesigned encounter that gives them more time, more support, and more direct access to their physician while also expanding system capacity.
“Our capacity, our clinicians’ time, is one of our most precious resources. There's more demand than there is capacity, and that's never been truer for healthcare systems.”
– VP, Access Transformation, Cleveland Clinic
To tackle access, Cleveland Clinic is redesigning the visit itself, not just the schedule or the staffing model. Instead of asking, “How do we squeeze another individual visit onto the calendar or shift care to an APP?” Cleveland Clinic asked, “How do we redesign the visit so one encounter with the provider can safely serve more people, without diluting quality?” Shared Medical Appointments became a force multiplier for both capacity and experience. Shared care, especially when combined with virtual delivery, can provide a higher level of service for patients and a more sustainable workload for clinicians. For many chronic and high-need conditions, the right level of care can be shared, virtual care: a model that delivers higher clinical touch, more support, and more access in a single 90-minute block.
What happened?
Cleveland Clinic expanded Shared Medical Appointments across more than 100 chronic and high-need conditions, redesigning the standard visit into a 90-minute group encounter supported by a physician, a facilitator, and some clinical support staff. Post-COVID, most SMAs shifted to virtual delivery, allowing patients to join sessions more easily and enabling physicians to serve more people in the same block of time.
Why did it work?
The group format increased touchpoints without increasing physician hours, while virtual sessions removed room constraints and improved convenience for both patients and providers. The model required relatively low financial investment because it relied on existing staff, standard visit templates, and routine EHR workflows. ROI can be achieved once 6-7 patients attend a session, though the number of optimal patients varies with the type and length of the visit leveraged. SMAs also have high patient satisfaction rates. Starting slow and proving success in visible ways allowed Cleveland Clinic to expand into the largest SMA program that exists today.
“There was tremendous adoption both quickly by the patients and the providers, and now it's hard to talk people into the in-person model because of the ease, the technology, and the fact that a caregiver can join without taking a whole day off of work. The impact on access has been really transformational.”
– Director of SMAs, Cleveland Clinic
Results
Some clinicians experience an increase from 60% to 80% in productivity after integrating SMAs (based on change in visit volume)
Adds 6-8 extra patients per provider for each SMA conducted compared to one-to-one appointments conducted in a 90 minute period.
Next-available appointment reduced by ~50% on average
Read the full Cleveland Clinic case study here.
Insight 2: What if the right place of care is revealed through centralization?
Throughput is not always included in the same breath as access, but it is a core access problem. Even when patients can get into the system, they can get stuck moving through it, which backs up incoming patients. The right place of care is about clinical appropriateness, but it is also about visibility, coordination, timing, and moving a patient smoothly through the system. When these elements are missing or neglected, bottlenecks can emerge and delays can build up.
Consider a patient who arrives at a community ED, and the team determines she needs a higher level of care. In some systems, the transfer process may still be driven by individual phone calls to different hospitals, fragmented criteria, and waiting for callbacks. Once a hospital agrees to receive her, bed placement might happen through a separate process. Maybe a bed opens in the ICU, but a delay in communication means the patient continues to occupy an ED bay while the ICU bed is held for her. For a period, she is “occupying” two beds at once. Later in the stay, when she is ready for discharge, the referral for follow-up care may sit in a fax queue or a local worklist and slip through the cracks. If it is the patient’s responsibility to schedule their referral, they may never complete the process.
Each small delay compounds into longer boarding times, missed opportunities to see additional ED patients, and avoidable leakage when patients fall out of the system instead of being guided to appropriate follow-up. Multiply this by dozens or hundreds of patients across a system, and it can add up significantly. The system might erroneously begin to operate as though capacity must be built or hired, rather than revealed through more efficient flow.
Centralization can change the math on throughput. Inova recognized that access and flow are two sides of the same coin: effective entry into the system depends, in part, on the ability to move patients through it efficiently.
What happened?
“Access isn’t a project—it’s an entire strategic portfolio of work for our organization.”
– VP, Clinical Operations, Inova Health
Inova built a shared command structure so that the ‘where’ of care is determined at a system level, using real-time, shared information and streamlined processes. Each initiative addresses a different throughput bottleneck. First, a Transfer Center serves as a single intake and coordination point for internal and external transfers. Second, the Centralized Bed Management team oversees real-time placement across campuses and prevents the “two beds at once” problem by managing timing and handoffs. Third, the Unified Referral Backbone created centralized work queues, standardized intake requirements, and prevented delays by having schedulers proactively reach out to patients.
Why did it work?
With one coordinated hub making placement and transfer decisions across sites, the system can see what no individual unit can: where beds are truly available, which patients can move now, and how to balance flow across campuses. Inova’s approach also emphasizes redeploying and centralizing existing resources under the High Reliability Operations Center, rather than adding net new FTEs.
“We are not inadvertently overloading one care site…we can get patients their next test or treatment faster than waiting at the care site they’re currently in.”
– VP, Clinical Operations, Inova Health
Results
42% increase in accepted external transfers
40-minute reduction in bed request-to-placement time
39 additional ER patients seen daily without additional resources
25% year-over-year reduction in inpatient boarder hours (2022–2024)
Streamlined referral-to-scheduling workflows for 29 specialties
Read the full Inova case study here.
Insight 3: What if the right time of care is earlier than you think is possible?
Across our interviews, leaders described a familiar pressure: patients want to be seen sooner, while clinicians and teams feel they are already operating at (or over) capacity. Yet the case studies in this series demonstrate that the timeline of access is often far more malleable than it appears. “Right time” is often interpreted as “soon enough.” In practice, systems that pull ahead reframe it as “sooner than we thought possible.” They design models that bring patients into effective care earlier in the arc of their condition and earlier in the daily or weekly flow of the organization. That shift guides patients through an intuitive floor plan of care, reduces downstream congestion, and reveals capacity that would otherwise remain hidden.
Cleveland Clinic’s Shared Medical Appointments created earlier touchpoints, by 50% on average, for chronic disease patients by fundamentally changing the encounter type. Instead of waiting for individual visits, patients gained faster access to their physician through the group model, which allowed the addition of 6-8 patients per provider for each SMA. The “right time of care” became sooner because the visit model no longer depended on one-by-one throughput.
Time also changes when systems tackle the hidden inefficiencies that delay care. Inova’s work standardizing transfers, bed placement, and referral routing tackled the fragmented visibility that constrained patient movement. They were able to manage a 40-minute reduction in bed request-to-placement time and a 25% year-over-year reduction in inpatient boarder hours. Eliminating the slowdowns does not create new time, but it returns lost time to the system. The “right time of care” becomes sooner because bottlenecks are removed.
And sometimes the “right time” requires a bold reframing of what is possible. Emory showed that during its access sprint, Emory NOW. By asking, “What would it take to see every patient today or tomorrow?” leadership set a timeline that felt impossible under prior assumptions. They did not add clinical FTEs. They redesigned expectations, standardized templates, and used real-time oversight to smooth variation. The sprint proved that earlier care was achievable by changing how the system organized time.
Read the full Emory case study here.
Conclusion
Across all three articles in this series, one key theme has emerged: access improves most when systems challenge assumptions.
Whether it is redefining the visit, centralizing decisions that shape throughput, using AI to address needs, or reimagining how quickly patients can be connected to care, the systems highlighted are proving that timeliness is malleable. Seeing patients sooner is possible when care models, operational structures, and expectations shift together. As organizations continue to confront rising demand and workforce pressure, the next wave of access improvement will come from redesigning how patients enter the system, but also how they move through it. They are reenvisioning and expanding what “right” means as they seek to deliver the right level of care at the right time and place. In doing so, they are seeing expanded access using largely already existing personnel and facilities.
This article is the final in a series examining how health systems are redefining access to care. The previous articles explored how culture forms the foundation for access transformation and how systems can move beyond the “front door” metaphor for access into a more expansive floor plan of streamlined pathways.
Acknowledgement
Strategy Catalyst would like to thank the health system leaders from Cleveland Clinic, Inova Health, and Emory for their time, insight, and generosity in sharing the lessons and outcomes of their impactful work.