Two years ago, the waiting rooms at Confluence Health clinics were full of patients. Now, however, the magazines and patient pamphlets on hand are gathering dust.
But that is not a sign that the North Central Washington-based health system has fallen on hard times. It’s just the opposite. An all-out effort to change the way primary care services are delivered has resulted in more patient visits than ever—all while letting them sail through the waiting room.
Confluence Health reports that its exam rooms are full, its waiting rooms are empty, and more patients are being seen because of the primary care redesign.
Confluence Health, which serves Washington’s Chelan, Douglas, Grant and Okanogan counties, is a member of the AMA Health System Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Previously, there were struggles to meet expectations regarding ready access, diverse availability, easy scheduling and offering patients a variety of care options. Confluence Health leaders came to see that more than tweaks to the system were needed.
So the health system embarked on an 18-month process to transform how and when primary care visits take place. This included bringing in outside experts, experimenting with new concepts, making scheduling easier and offering virtual visits.
“The main problem that we were trying to address is providing our community with convenient access to primary care,” said Elizabeth Avena, MD, Confluence Health’s core medical director for primary care.
“We weren't meeting our community and our patients' expectations,” Dr. Avena added. “We had a significant access issue and an aging population needing to access care. We embarked on this journey so that we could better fulfill our mission, serve our community and provide access for all.”
One discouraging statistic was that new patients sometimes had to wait more than 50 days for their first appointment. That is now down to 17 days—a 66% drop.
System leaders noted that they feel responsible and accountable to care for the patients in their four-county coverage area and to provide the primary care services they need.
Confluence Health has 15 clinics and one hospital with two campuses, and care is delivered by more than 300 physicians and 170 nonphysician providers.
Creating more capacity for care
“We also recognized that we were going to be delivering care to a larger population of people and with fewer resources to do so in the future,” Dr. Avena said, noting that the region faces health workforce shortages.
“How do we design a system that accomplishes that, allows our patients to access us when they need us, and is also a sustainable system—not only for our organization, but also our physicians?” she added.
“So, that's where we started,” Dr. Avena explained. “The goal that we landed on was to preserve the personal connection between patients and physicians by creating capacity for care in the clinic when it's most important and then offering convenient avenues for care for other patient needs.”
Physicians joined teams with other health professionals, administrators and support staff with separate groups tackling convenient care, chronic care, complex care and wellness.
The teams targeted problems, set goals and created new systems based on common design principles.
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“The design principles were: Distributing care to the right place, reserving the clinic for focused, patient-centric care that needed to take place in the clinic, maximizing our existing tools and leveraging digital tools, emphasizing proactive targeted care, using automation where we could, leveraging outside partners for care that we were not able to offer, and to simplify navigation,” Dr. Avena said.
A key development was adding same-day and next-day online appointments for Confluence Health’s walk-in clinics.
“We still accommodate walk-in patients, but what has been amazing is that online scheduling allowed us to see a higher volume of patients,” Dr. Avena said.
“We used to have times where our walk-in clinics would have a two- or more-hour wait for appointments,” she added. “Now for the most part, patients arrive close to their appointment time and are seen right away.”
Another big benefit is that physicians and other health professionals are able to leave work on time.
Creating digital care options
To reserve clinic space for patients who needed to be seen in person, different care modalities were provided for patients to access care conveniently.
On one such option, the system is partnering with KeyCare, a virtual urgent-care company whose services patients can access through their Confluence Health MyChart account.
This arrangement was rolled out in October and allows KeyCare health professionals to access patients’ Confluence Health records. KeyCare then produces a visit note from the encounter that is entered into the patients’ file and can be viewed by their primary care physician.
“Our patients seem to have magically found their way to it without very much advertising,” Dr. Avena said. “It is well utilized, and it especially helps offload our direct-care clinics during very busy times, plus on nights and weekends.”
Another digital option is Care Companion, which helps patients manage their chronic conditions such as diabetes and hypertension by providing medication reminders and educational content. It also assists them in monitoring their vital signs and communicating with their care team.
“It doesn't require our patients to come into clinic as often as before,” Dr. Avena said. “The whole purpose of that is to offload the clinic visits, so that, when they do come in, it's more focused for the patient—and also for the physician—so that we're not trying to take care of 20 different problems in a 20-minute visit.”
In 2024, 70.7% of Confluence Health had their BP rates under control systemwide. This was the system’s best year to date and surpassed its goal of 69.4%. In primary care, Confluence Health achieved 74.4% control.
A Care Companion program for pregnancy and postpartum care also went live in April 2025.
