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Empanelment Foundation for and Heart of the Medical Home Presented by: Regina Neal, MPH, MS Preservation Park Oakland, California July 21, 2016
EmpanelmentFoundation for and Heart of the Medical Home
Presented by: Regina Neal, MPH, MS
Preservation ParkOakland, California
July 21, 2016
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THANK YOU TO OUR HOSTS AND SUPPORTERS
Alameda Health ConsortiumCommunity Health Center Network
California Improvement Network
The California HealthCare Foundation
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Welcome, Introductions
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Learning ObjectivesBy the end of this training you will be able to:
• Identify and use the steps to create panels
• Apply specific principles and tactics to respond to typical challenges in empanelment in your practice
• Plan, lead, implement and support an on‐going empanelment process for the practice
• Develop and use data to assess key empanelment, population health management and quality metrics in the practice
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Ground RulesAgreements to Optimize Learning
• Be engaged– Participate, share ideas, ask questions
• Leave titles at the door– Give everyone an equal voice
• Be open‐minded– Respect all ideas and opinions
• Use technology sparingly– If you have to take a call, please step out of the room
• One conversation at a time• Have fun!
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Live Twitter feed!
• Aha Moments / Inspirations• Questions I have…• When I get home I will…
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EmpanelmentA deliberate set of actions to
identify the group of patients for whom a primary care clinician and
care team are responsible.
“Empanelment is a vital enabler of many elementsof high‐performing primary care.”
Source: Kevin Grumbach, MD, and J. Nwando Olayiwola, MD, MPHJABFM March–April 2015 Vol. 28 No. 2
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All Systems are Designed Perfectly to Give the Results You Get
Like Magic? (“Every system is perfectly designed…”)http://tinyurl.com/hoqyerx
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Think Different
11Wagner EH, Coleman K, Reid RJ, Phillips K, Abrams MK, Sugarman JR. The Changes Involved in Patient-Centered Medical Home Transformation. Primary Care: Clinics in Office Practice. 2012; 39:241-259.
Change Concepts for Practice Transformation
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Importance of Empanelment to Transformation
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Empanelment Key Changes• Assess practice supply and demand to determine “right‐size” for each provider’s panel
• Assign all patients to a provider panel and confirm assignments with providers and patients
• Review and update panel assignments on a regular on‐going basis to ensure all panels remain right‐sized and current
• Establish process for re‐empaneling patients when providers or residents change clinical time or leave
• Provide care teams with panel specific data (registries) to enable them to proactively plan care, close gaps, and track patients
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Empanelment →Team‐Based Care, Continuity, Access, Relationships, Outcomes
New Goals, New Thinking, Improved Results
Whose Patient Is It? Our Team’s Patients
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System Design for EmpanelmentSuccess Depends on Balancebetween Supply and Demand
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Why Supply and Demand Matter
• Enable access and continuity to be reliable features of the system
• When not in balance, workload inequity can create tension among providers and staff
• Too large: delays for appointments, deflections, discontinuity, rework, overwork
• Too small: demand may not be adequate to support the practice financial needs
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• Of concern due to increasing expectations on managing and coordinating care for populations
• Without panels, provider handicapped when attempting to perform advanced primary care functions
J Am Board Fam Med 2015;28:173–174
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The Work Going Forward
“Given the difficulty so many ofthe respondents had in estimating panel size, we
suspect that much of the variation reflects inattentionto systematically measuring, standardizing,
and addressing panel size as a core element ofpractice management.”
Source: Kevin Grumbach, MD, and J. Nwando Olayiwola, MD, MPHJABFM March–April 2015 Vol. 28 No. 2
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Empanelment: Steps in the Process• Leaders commit organization, time and resources to initial
and ongoing processes for empanelment• Panels are created (S + D; 4‐cut; testing to learn what works; then scale implementation; involve providers, patients)
• Implement organizational processes to support continuity (scheduling) and population health management (panel‐specific registry data)
• Implement organizational processes (with on‐going staffing) to maintain right‐sized panels over time (panel management)
• Use data (visible, transparent) to monitor panel and practice level performance against goals and standards; act based on results
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All Patients Are Empaneled• Patients assigned to the practice or who opt to use the practice for care (select it as primary care provider) should all be empaneled.
• Empanelment is not the same as assignment from MCOs or other payers– assignment is to credentialed providers and not right‐sized– Need to assign patients to specific provider and care team
• Each practice needs to consider if there are any patient groups that would not be empaneled – This should be the exception in a very small number of specific cases
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Building Patient Panels
• Determine the “right‐size” for each provider panel using supply and demand data
• Determine current or de facto panels based on current patterns and place patients on one panel (use 4‐cut method)
• Engage providers in process to review and accept panel
• Engage patients to confirm PCP/team assignment; maintain relationships
• Finalize panels• Update panels regularly
Practice Panel
Provider Panels
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Data and Computing Power Needed
• Information systems, report generation and data manipulation and analysis capabilities to provide:– Supply– Demand– Data array of all visits by patient and by provider to determine the current, de facto, panels
– Apply the 4‐cut method to current data to form panels (each patient on one panel)
Leadership Enabled
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Information NeededProvider‐level data (Supply)• Provider clinical FTE and “supply” of appointments per yearPractice–level data (Patient Demand)• Unduplicated count of active primary care patients in the practice
over the past 15, 18 or 24 monthsActive defined as at least one visit in selected time period
• Total number of primary care visits made by these patients in same time frame (to estimate “demand” for service)
• Calculate average visits per patient per year (calculate from above data)
Patient‐level data (Current, de facto, Panels)• Visits by patient by provider for 15, 18 or 24 month time period
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The Mechanics of EmpanelmentBuilding Patient Panels
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Provider Supply• PCP is any provider who is expected to take care of a
panel of patients• For each PCP, determine their clinical FTE in the practice
– Clinical FTE is the time available to see patients; excludes admin, teaching, research, meeting, vacation and CME time
• Methods– # of visits expected per year– # of visits per session # sessions per year– # of visits/hour # of clinical hours expected per year
• Compare expected supply to actual visits seen– Number of actual patient visits seen in the past 12 months– How does it compare to expected?
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Calculate Provider Supply : Example #1
Provider Clinical FTE = 1.0 FTE (5 days per week)
Provider visits scheduled/day = 24Days in clinic/year = 5d/w 52w/y = 260 daysTime off = PTO, Holidays, CME = 20 + 10 + 5 = 35Clinical days = 260 – 35 = 225Appointment supply = 225 24 = 5,400
Visits seen in most recent 12 months: 5,670
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Calculate Provider Supply : Example #2
Provider Clinical FTE = 0.6 FTE (3 days per week)
Provider visits scheduled/day = 24Days in clinic/year = 3d/w 52w/y = 156 daysTime off = PTO, Holidays, CME = 12 + 6 + 5 = 23
daysClinical days = 156 – 23 = 133Appointment supply = 133 24 = 3,192
Visits seen in most recent 12 months: 3,574
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Calculate Provider Supply : Example #3
Provider Clinical FTE = 0.8 FTE (4 days per week)
Provider visits scheduled/day = 24Days in clinic/year = 4d/w 52w/y = 208 daysTime off = PTO, Holidays, CME = 16 + 8 + 5 = 29
daysClinical days = 208 – 29 = 179Appointment supply = 179 24 = 4,296
Visits seen in most recent 12 months: 3,792
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Provider 1 Provider 2 Provider 3
Provider Clinical FTE 1.0 0.6 0.8
Provider Visits/day 24 24 24
Clinical Days/year 260 156 208
Time off (days) 35 23 29
Clinical Daysavailable 225 133 179
Appointmentsupply 5,400 3,192 4,296
Visits in past 12 months 5,670 3,574 3,792
Provider Supply
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Provider Supply and Capacity
Community Health CenterProvider Supply
(Expected Visits)Capacity (Actual Visits)
Difference(Visits)
Goode (1.0 FTE) 5,400 5,670 +270
Monroe (0.6 FTE) 3,192 3,574 +382
Schafer (0.8 FTE) 4,296 3,792 -504
Jones (0.5FTE) – left practice
2,700 1,434 -1,266
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Patients (Demand) in Practice• What is the number of unique patients who have seen
any provider in the practice in a recent 15, 18 or 24 month period?– How many are pediatric patients (< 18 years of age)– How many are adults (≥ 18 years of age)
• Determine the total number of visits made by patients in the same 15, 18 or 24 month period for the following:– All patients– Pediatric patients – Adult patients
• For each group, calculate the average visits per patient in the period– Average visits per patient = # of patient visits for the group
÷the total # of patients in the group
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Demand for Visits: An Example
• Unduplicated number of patients in time period (15, 18 or 24 months)
• Total number of visits for these patients in time period
• Calculate average number of visits per year
Practice Patients and Visits (Demand)
Unduplicated Patient Count 4,057 patients
Total Visits 13,892 visits
Average Visits/Per Patient 3.4 visits/patient (average)
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What is the Current Panel?
Using the Four‐Cut Method
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Who’s on the Current Panel?• Determine the current de facto panel to determine if patients are all assigned to the right provider – Who did each patient actually see for each visit?
– Often patients see providers other than assigned provider
– Patients often see more than one and sometimes more than two providers in the practice
• These data will be used to assign patients to the panel of one provider
• Will not be 100% accurate but it is a good starting point for the process of establishing right‐sized patient panels with the right patients on them
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Patients by Provider (Current Panel)
Community Health CenterVisits by Patient and by Provider Seen
Provider Goode Monroe Schafer Former Provider
Assigned to Panel of…
Patient ↓
A…. 5 8 1 0
B… 1 1 1 7
C… 3 3 0 2
D… 6 0 0 1
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The 4-Cut Method for Panel AssignmentCUT PATIENT DESCRIPTION ASSIGNMENT
1 Patients who have seen only one provider To that sole provider
2Patients who have seen multiple providers, but one provider the majority of the time
To the majority provider
3Patients who have seen two or more providers equally (no majority can be determined)
To the provider who performed the last physical
4Patients without a physical or health check who have seen multiple providers
To provider seen most recently
Source: Murray et .al,. “Panel Size: How Many Patients Can One Doctor Manage?” Family Practice Management, April 2007
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4‐Cut Method Report
Community Health CenterVisits by Patient and by Provider Seen
Provider Goode Monroe Schafer Former Provider
Assigned to Panel of…
Patient ↓
A…. 5 8 1 0 Monroe
B… 1 1 1 7 Schafer1
C… 3 3 0 2 Monroe2
D… 6 0 0 1 Goode
1. Schafer did most recent PE2. No PE; Monroe did most recent visit
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Results
Community Health CenterProvider Panels (de facto using 4-Cut Method)
Provider Number of PatientsGoode 1,846Monroe 903Schafer 1,073Unassigned 276Total 4,098
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Is Current de facto Panel in Balance with Available Provide Supply and Capacity
• For each provider how does the current panel size calculated using the 4‐cut method (de facto) compare to the calculated size for the right‐size panel? Current panel size is about the same Current panel size is larger than the right‐size panel Current panel size is smaller than the right‐size panel
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Community Health CenterProvider Panels (de facto
using 4-Cut Method)
Panel Size Based on
S-D calculation
Assessment of Results
Provider Current Panel
S-D PanelSize
Over/Under Adjust?
Goode 1,846 1,588 +258 ?
Monroe 903 939 -36 ?
Schafer 1,073 1,264 -191 ?
Jones (left) -- -- Unassigned276
reassign
Assessing the Results
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Getting Panel Size Right
• Formulaic systems are very useful, but imperfect• The goal is to make a serious effort to appropriately match resources (supply) to need (demand)
• Whatever system is used should be both transparent and flexible
• Over time panel sizes will become more accurate
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Panel Size and Adjustments
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How Big Can a Panel Be?
• Panel size has some elasticity• Practice patterns and system design can influence maximum panel size possible
• Using teams who “share the care” is a key contributor to being able to manage larger panel sizes – recent study suggests delegation of preventive and chronic care tasks to non‐physician team members can allow team to care for a larger panel than would otherwise be possible
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Practice Patterns Influence Panel Size• Visits per patient per year
– Can decrease with continuity; lower visit return rate; provide more service at each visit; increase role of team members so all care not delivered by provider; use alternatives to traditional visits, e.g., telephone, email, group visits
• Provider visits per day– Increase by improving visit show rates; share the care among team
members; improve workflow efficiency; increase number of exam rooms; remove all unnecessary work from providers to maximize appointment supply
• Provider sessions or days per year– Do as much as possible to protect provider time during patient care
hours from non‐patient care activities; e.g., incorporate administrative time duties into the work of the team; use non‐patient care hours for meetings
46Source: Murray et .al,. Panel Size: How Many Patients Can One Doctor Manage? Family Practice Management, April 2007.
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Team‐Based Care Influence on Panel Size• Findings from study
– If portions of preventive and chronic care services are delegated to non-physician team members, practice panels of larger size are possible
Type of DelegationPrevent/ChronicDelegation NONE(% = 0/0)
Prevent/Chronic Delegation LOW(% =50/25)
Prevent/ChronicDelegation MED(% = 60/30)
Prevent/ChronicDelegation HIGH(% = 77/47)
Panel Size 983 1,387 1,523 1,947
% Increase from Base 41% 55% 98%
Source: Altschuler, et.al., Estimating a Reasonable Panel Size for Primary Care Physicians with Team‐based TaskDelegation. Annals of Family Medicine, Vol 10, No. 5; September/October 2012
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What About Adjusting for Type of Patient, Acuity, Complexity?
• Most asked about: adjustments for complexity, acuity• Most useful: age‐gender adjustments
Remember…One panel adjusted down requires another to be adjusted up
– Can lead to a complicated process within the practice– Can stall or delay the process without material improvement in panel sizes
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Adjusting for Age and Gender
Source: Murray et .al,. Panel Size: How Many Patients Can One Doctor Manage? Family Practice Management, April 2007.
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Try Redesign and Teams First
“Practices should consider whether many of the age and acuity factors could be managed more effectively by providing focused team support than by adjusting
panels.”‐‐ Mark Murray
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Assessing Panel Size• Saying “yes” can mean “no” if we can’t provide what the patient
needs and wants, can’t maintain access with continuity• Leads to escalating chaos within the practice, increase in rework,
decrease in outcomes and experience; burnout, decreased patient experience and poorer outcomes
• To maintain panels at right size, you may find you need to add more providers.
• Recommended: First try the following (redesign, improvement approaches)─ build teams; redesign workflows; exploit power of technology; eliminate needless work and re‐work; add staff to do the right work e.g., care coordinators, care managers, pharmacists, behavioral health, etc.
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Adjusting a Panel That Is Too Large
• Bolster the care team: shift more resources to support the provider & care team, e.g., additional nursing and/or clerical support; additional exam rooms
• Excuse the provider from seeing patients of absent providers
• Let attrition take its course• Close the panel temporarily• Move patients to another panel. Develop a patient‐centered and thoughtful process– Providers need to inform their patients directly
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What if the Panel is Too Small?
• Develop a plan to grow a small panel• Consider whether the provider is new to practice or an experienced provider
• Use the opportunity to move patients if it makes sense from panels that may be too large or from providers who are reducing FTE or may be leaving the practice– Always consider the patient’s desires in any plan to redistribute patients to a different panel
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Community Health CenterProvider Panels (de facto
using 4-Cut Method)
Panel Size Based on
S-D calculation
Assessment of Results
Provider Current Panel
S-D PanelSize
Over/Under Adjust?
Goode 1,846 1,588 +258 ?
Monroe 903 939 -36 ?
Schafer 1,073 1,264 -191 ?
Jones (left) -- -- Unassigned276
reassign
Assessing the Results
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Engage Providers and Teams in the Process
• Medical leadership is essential in this process• Use a process designed to engage providers and care teams so panels are accepted, embraced, owned– Consider their suggestions seriously– Have providers talk together as a group– The Practice’s patients are the responsibility of the whole Practice so decisions need to ensure all patients are on a panel which is their medical home
• Allow all providers to review their panel as thoroughly as they want; encourage discussion, questions
Source Amit Shah, MD, Multnomah County, OR
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Confirm Panel with Providers
• Review de facto panel and ideal panel size with providers to engage them in process and develop ownership of their panel– This is an ongoing process from beginning
– Medical leadership is essential
– Start with goals, benefits
– Review process, methods, data
– Have a dialogue (on‐going) about goals, benefits, concerns, process for assessment, making adjustments
– What data will you use to assess outcome goals and panel size over time?
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Engage Patients in the Process Too
• Involve patients by checking with them when they come into the clinic to confirm that they agree that Dr. Smith or the NP, Ms. Jones, is their provider
• When patients call the clinic always ask “who is your assigned provider?” and ensure that the call is routed to the right care team
• Communicate and reinforce provider–patient link in as many ways as possible to emphasize continuity and access to the care team vs. to an appointment with any provider
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Are Panels Working? Don’t Guess. Measure. • Use metrics to assess – periodic reports
– Panel size compared to right‐size; assess based on results– Operational and clinical measures
• % of all patients empanelled• Continuity rate for patients by panel• 3rd next available for patients by panel• Clinical outcomes
• Ask patients how it is working for them (experience)– Can they get an appointment easily when they want it?– Are they seeing their provider and care team regularly?
• Ask staff how it is working from their point of view– Are they able to manage the demand?– Are they able to use registry data for planned care, outreach
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Principles for Successful Empanelment
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Create the Climate for Change
Engage and Enable the Organization
Implement and Sustain Changes
Leading ChangeWhat It Takes
• Drive the Urgency• Build the Guiding Coalition • Develop Vision (What, Where),
Connect to the Strategies (How)
• Build, Sustain Communication Campaign
• Empower Action; Remove Barriers to Action
• Build Belief with Early “Wins”
• Keep It Going; Don’t Let Up
• Make It Permanent (Anchor in Org. Culture)
Based on John Kotter, Leading Change, 1996
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Create the Climate for Change
Engage and Enable the Organization
Implement and Sustain Changes
Leading ChangeHow It Works
Based on John Kotter, Leading Change, 1996
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Principles to Enable Successful Empanelment• Organizational resources (including the time needed, an
improvement team, engaged leadership) to support initial and on‐going empanelment are readily available
• Process and results of empanelment are patient‐centered and give patient a dependable medical home in the practice and respects patient’s preferences
• Processes to create right‐sized panels are transparent and engage providers and care teams as stakeholders
• Processes consider the care team as the point of continuity for patients on the panel
• Operational processes are developed and prioritize continuity and access for patients and for care teams
• Teams have time, tools, training and authority to develop processes for managing their panel through shared care and population health management
• Teams have access to data for their panel and take accountability for their panel and outcomes (access, continuity, experience and clinical)
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Empanelment Process Takes Time• Started with pilot clinic
to ensure the process worked
• Process took 6 months for all clinics
• Had empanelled 99% of patients within 8 months; had started with 6,000 unassigned patients , many more assigned to an incorrect provider
• Implementation of new processes were maintained post‐empanelment
Source Amit Shah, MD, Multnomah County, OR
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Create panel for one provider
Begin team-based care
Create panel for 2nd provider
Develop, Implement changes to support continuity
Develop, implement policies to support empanelment
Create panels for remaining providers
Provide registries, patient data
Develop, use performance data Empanelment
Tasks
1 2 3 4 5 6 7 8 9 10 11 12Months
Implementation Timeline Example
Build commitment for the change throughout the practice
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Gnarly Issues
Let’s Discuss
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Which Patients are Empaneled?
• Medical home is proactive; empanels patients assigned or who choose the practice as their provider organization
• Have process to assign new patients to panels– Explain process to patient, assess preferences, confirm assignment; provide information on team (do warm introduction if possible)
– Share information on new patient to provider and care team
• Have processes to reach out to the patient to begin engagement process for the patient and assess need for visit or initial health assessment
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Which Providers Should Have a Panel?
• All providers > 60% FTE• Providers 40‐60% FTE share a panel or cover for each other
• Providers < 40% FTE work locums to provide coverage in the practice (no assigned panel)
• NPs: two options– as PCP, empanel, using same sizing as for provider– on team with physician sharing panel (factor into supply for panel size); provider and NP determine delegation of responsibility
• PAs: shared panel with physician provider (factor into supply for panel size)
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Fears and Misperceptions About Empanelment
“My patients will have less access. How can they see me since my schedule is fully booked for the next five
months. Assigning patients to me will only make this worse. This won’t benefit me or my patients.”
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Invest in the Care Team to Enhance Continuity, Access
Teams are forged by the work they do together to achieve their common
purpose
SOURCE: Katzenbach, J. R. and Smith, D.K. (1993), The Wisdom of Teams: Creating the High‐performance Organization, Harvard Business School Press
• Team small group of people; complementary skills; committed to a common purpose, performance goals and approach for which they are mutually accountable
• Team challenges are complex enough to require the skills, experience, training of more than one person to be successfully completed
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Linking Empanelment to Appointment Scheduling for Continuity
• Ensure that scheduling is done to prioritize continuity for patient with provider and care team– It is easy for scheduling process to revert to looking for the next available provider vs. the assigned provider
– Address access delays• Use scripts at clinic reception during check‐in, and when
making appointments to validate patient’s provider and patient preference to maintain panels. Standardize the process
• Monitor data to ensure access and continuity
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Part‐Time Providers, Coverage, FTE Minimums
• Establish minimum clinical FTE for providers
• Establish minimum number of days per week in clinic
• Partner part‐time providers (2‐3) for coverage of panel over all sessions for a week, no gaps
• No overlapping vacation schedules for partners
Source Amit Shah, MD, Multnomah County, OR
Leadership Enabled
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Considerations for Part‐Time Providers• Create “practice partners” by pairing part‐time providers in a shared practice/panel situation:• Pair up to equal one FTE• Compatibility, Chemistry• Share a care team for continuity purposes • Coordinate and share to ensure coverage during vacations and other time off
• Communication is key; schedule to enable face‐to‐face contact at least one time per week to foster communication
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Provider (or Resident) Leaving the Practice, On Long Term Leave, Reducing Clinical Time
• Risks to patients during provider transitions– Patient loss to follow‐up or timely follow‐up– Missed test results– Delayed care– Medical errors– More acute care (E.D. and hospital)
• Patients can lose trust in practice and lose momentum around their own self‐management
• Other teams taking up the demand of absent provider– Reduces access and continuity for their patients– Discontinuity, deflection, delay in access and care– Burnout, staff and provider dissatisfaction– Poor patient experience
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Provider (or Resident) Leaving the Practice, On Long Term Leave, Reducing Clinical Time
The Opportunity
How can we design, implement and anchor processes for high quality transitions for provider transitions to ensure the best planned and implemented patient
hand‐offs between providers?
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What to Do: Plan and Prepare Well • Design and use standard processes for managing a provider transitions Provide notice to allow for adequate preparation to ensure smooth
transitions for patients and other teams Ensure all providers and teams know the processes and their roles Identify patients that will have a transition (permanent or temporary) Define and identify high‐risk and fragile patients who will be
prioritized for person‐to‐person hand‐off process Decide who will provide care to other patients if there will be any
gaps or long term provider absences that will not be filled quickly Commit to not allow gaps in transitions even if using locums or other
providers as temporary coverage. Design a process to inform patients about the transition and a
mechanism to provide real‐time responses to their concerns
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What to Do: Implement well
• Provide protected time for hand‐off process between providers and care teams
• Preserve relationships between patients and care team– Design effective processes for keeping the care team of transitioning
provider involved as much as possible; the team knows the patients.• Prioritize use of warm hand‐offs for high‐risk patients and other
patients as possible to introduce new provider; maintain care team
• Establish a process to minimize loss to follow‐up for high‐risk and fragile patients Next visits in timeframe intended (prioritize scheduling with right provider) Completion of testing processes as needed (and track for completion)
• Engage clinic operations staff to help with scheduling
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What to Do: Get Feedback, Improve Processes
• Get feedback (prioritize real‐time asking vs. survey)– from patients– from providers and care teams involved
• Track data to evaluate effectiveness– access, continuity, clinical goals
• Use learning to refine process over time
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“In the choice between changing one’s mind and proving there's no need to do so,
most people get busy on the proof.”‐John Kenneth Galbraith
Source: http://www.brainyquote.com/quotes/quotes/j/johnkennet121078.htm l
Resistance
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Principles for Overcoming Resistance to Change
• It is natural and inevitable: Expect it• It does not always show its face: Find it• It has many motivations: Understand it• When you meet it, deal with concerns rather than arguments: Confront it
• There is no one way to deal with it: Manage it
Hammer, Michael & Steven A. Stanton, The Reengineering Revolution, Harper Business, 1995
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Make Empanelment Permanent
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Maintaining Panels in Practice
• The empanelment process needs to be used regularly to keep panels right‐sized over time
• Requires processes to:
– Ensure all new practice patients are linked to a specific provider as soon as they are assigned or choose the practice as their medical home; develop outreach process as well
– Develop a process for patient or provider request for switching a patient panel assignment
– To re‐empanel patients whose providers leave the practice or cut back their clinical time (see info on minimum FTE)
– Remove patients who are no longer using the practice
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Build an Empanelment Process• Define Roles and Responsibilities
– Assign a Panel Manager to oversee all processes for empanelment– Identify other staff needed
• Develop standard process for PCP assignments– Initial for new patients
– Patients leaving practice, providers leaving practice or changing their clinical FTE
– Patient or provider requested move of patient to another panel
• Run supply and demand data periodically to ensure panel size is neither too large or too small
• Identify unassigned patients monthly and develop process for assigning
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Examples of Policies for Panel Management
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Population Health Management
“Primary care physicians will increasingly be paid for their ability to achieve goals across the body of patients most closely associated with them: their ‘panel’.”
J Am Board Fam Med 2015;28:173–174
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Empanelment and Data Driven Improvement
• Triple Aim & Value‐based Payment– Population‐based clinical and experience results expected, required
• Feedback for teams and organization for continuous improvement efforts to achieve highest levels of performance
• Absent empanelment process, who how are these outcomes achieved and sustained?
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Adult Population Risk Distribution
At Risk for Poor Health (20%)
Severe Problems
(5%)
Chronic Conditions (40%)
Generally Healthy (35%)
Population Health Strategies :1. Manage
patients effectively and efficiently at each level
2. Keep patients from moving up the pyramid
3. Ensure a good medical home
Source: Kevin Grumbach, M.D., UCSF. Webinar, “Patient Empanelment”, July 18, 2016
40-50% costs
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Using Panel Data for Outreach and PHM
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Performance Results
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What Will You Do to Advance Empanelment in Your Practice?
• Identify two to three action steps that you will take as soon as tomorrow
• How will these support your work to move forward?• Who is accountable for each step?• How confident are you that you can complete these actions and then take the next set of steps to create momentum?
• Whose support do you need? How will you secure it?
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Check‐in for Progress• Two to three weeks after the
training session– hold a virtual office‐hours session (60
minutes) – 2 dates and times– to take questions from training
participants– hear about the progress and
challenges– Seek solutions
• This is an opportunity to increase the likelihood that the empanelment effort will be completed and thereby produce the ROI that it offers for continuity, access, team development, population health management
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Feedback
1. Overall usefulness of the training (scale 1 to 5)2. I can use what I learned (yes or no)3. Most important thing I learned (post‐it note)4. Confidence about taking actions (scale 1 to 5)5. Suggestions to improve this training (post‐it note)
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Thank You
