Volumes have rebounded from the pandemic, but providers face a shifting case mix and structural changes that suggest inpatient volumes are unlikely to look the same as they did pre-pandemic. In response to this “new normal,” some providers are expanding their target markets to maintain or grow enough volume to sustain their programs. In some cases, providers tread on catchment areas of competing programs.

A recent Advisory Board analysis found that out-of-market surgical travel is common and often elective. This travel occurs most frequently in high-profit — and therefore financially critical — sub-service lines. Out-of-market travel can be especially problematic when outflow affects services like oncology that are central to systems’ growth strategies, as was the case for FirstHealth of the Carolinas.

FirstHealth lost 16% of its oncology market share from 2018 to 2022. Over that period, they found their patients were traveling to receive care at either of two well-branded academic medical systems that built new cancer centers in neighboring markets.

FirstHealth of the Carolinas is a not-for-profit healthcare system serving 15 counties in central North Carolina. Headquartered in Pinehurst, NC, FirstHealth has four hospitals with 546 beds and over 6,300 employees. The organization opened a 120,000 square foot cancer center in March 2023 that offers cancer care, palliative care, and patient and family support services.

To defend against volume loss to competitors within driving distance, FirstHealth used internal and external data sources to identify the root causes of patient leakage. FirstHealth then doubled down on improving the patient care journey to recapture and retain market share.

FirstHealth began by analyzing the root cause of their volume loss to identify why patients were leaving. The data revealed that appointment wait times and lack of brand recognition for oncology compared to their peers in academic medical centers were pushing patients out of market. They first tackled wait times by increasing provider capacity. 

After achieving their wait time goals, FirstHealth designed a new cancer center that offered comprehensive services for patients and their families and optimized provider efficiency. Although leaders bet that geographic proximity would help retain local patients and prevent out-migration, they knew travel distance wasn’t the only root cause. Therefore, they also engineered a new, easy, and appealing care journey. Unexpectedly, the most important part of their strategy was engineering an easy and appealing care journey.

By transforming the patient journey and designing a new cancer center, FirstHealth reduced wait times for an initial oncology visit from 14 days to an average of less than 5 days. The system successfully increased oncology patient volumes by 25%. Most of these were patients in their service area who they previously would have lost to out-of-market travel. Capturing these volumes led to an 84% increase in associated revenues.