Practice Facilitation Handbook
Module 20. Facilitating Panel Management
A panel is a list of patients assigned to each care team in the practice. The care team (e.g., a physician, a medical assistant, and a health educator) is responsible for preventive care, disease management, and acute care for all the patients on its panel. This means that a patient will have the opportunity to receive care from the same clinician and his or her care team.
What Is Panel Management?
Panel management, also known as population management, is a proactive approach to health care. “Population” means the panel of patients associated with a provider or care team. Population-based care means that the care team is concerned with the health of the entire population of its patients, not just those who come in for visits. For example, a care team with a panel of 1,500 patients would be concerned about the health care needs of the entire 1,500. The team would work on anticipating and planning for this care proactively (in advance) rather than reactively (when the patient shows up for a visit and requests care).
Why Is Panel Management Important?
Some practices do not use panels and operate more as acute care centers—services rendered to patients needing urgent medical attention (e.g., infection, injuries, or flu). In most community health care centers, patients are scheduled with whichever physician is available as opposed to an assigned provider. This is the old reactive model of care and one that does not help build relationships with patients.
The Care Model and patient-centered medical home (PCMH) concepts require a different approach to care. Instead of thinking about patients episodically (a string of loosely connected appointments), practices must find ways to proactively reach out and develop continued relationships with their patients to provide continuity of care. Continuity of care is designed to provide higher quality of care to patients by providing consistent care over time through a primary care provider.
Assigning patients to particular clinicians or care teams helps change this approach. It designates teams responsible for caring for specific patients and supports continuous relationships between patients and their care teams. It also makes it possible for care teams to “manage” care not just for individual patients as they appear, but to plan care for all of the patients assigned to their panel.
|Empanelment must be an early change on the journey to becoming a PCMH, because other key changes such as continuous, team-based health relationships, enhanced access, population-based care, and care coordination depend on the presence of such linkages.
–Katie Coleman and Kathryn Philips
Care teams oversee and track proactively the care needs of the patients on their panel and ensure that patients receive the services they need to optimize their health and well-being. Creating panels also makes it possible to monitor the performance of care teams with their assigned patients and monitor how effectively they are providing needed services to each patient in their panel.
Does Panel Size Matter?
The first question most practices will ask is, “Is patient panel size important?” The best answer is, yes, size matters. Imagine a clinician who is seeing too few patients. That may be great for him or her because the workload is lighter but not so great for other clinicians in the practice who are working into the evenings to keep up. You can imagine that it wouldn’t take long for resentment to build among clinicians.
On the flip side, a clinician with a patient panel size that is too large is not effective. Patients may find it hard to get in to see their clinician, workloads may be deflected to others in the practice, and frustration will increase. The goal is to find balance in the practice between supply (time offered by the clinician) and demand (the need for the patient to be seen).
How Large Should a Panel Be?
The average panel size for a care team is 1,500 or 2,000 patients. Panel size is calculated by taking the clinician’s “supply” of visit slots and dividing it by the average number of visits by a typical patient during a year. The result is the total number of unduplicated patients a clinician can care for in a year. For example:
- A clinician who works 230 workdays in a year and sees 24 patients a day has a “supply” of 5,520 slots a year (230 workdays x 24 patients/day).
- Patients average 3.19 visits to the clinician a year.
- This clinician could care for a panel of 1,730 average patients in a year (5,520 ÷ 3.19).
As noted in Module 19, however, a clinician working alone would not be able to care adequately for a panel that size. It is only through the delegation of care tasks among team members that a care team can provide high-quality care to this many patients. A resource for calculating panel size is the Patient Panel Size Worksheet in the Family Practice Management article available at: http://www.aafp.org/fpm/2007/0400/p44.html.
What Variables Affect Panel Size?
Empaneling the patients in a practice is not as simple as taking the total number of patients divided by the total number of care teams. In reality, dividing patients among care teams in a practice can entail using some complicated formulas that rely on additional information. You need to consider factors such as how many hours clinicians devote to patient care (vs. administrative duties or other responsibilities) and the types of patients they typically care for. For example, more complex patients require more frequent and longer visits. Similarly, obstetric patients have a period of high-intensity care. A clinician who sees many of these patients would be able to care for fewer patients.
The size and skill level of the care team will also affect panel size. A clinician who has teammates who can take over complex or specialized care tasks (e.g., dietitian, pharmacist, phlebotomist, health educator) can see more patients in a day than a clinician who has a single medical assistant on the care team.
Finally, panel size will need to be adjusted to accommodate part-time clinicians and the unique practice requirements for residents if they are present in a practice.
How Do You Assign Patients to Panels?
Here are some steps for assigning patients to clinicians’ panels:
- Begin by reviewing patient visit records to determine if there are patients who have seen only one provider. If so, assign those patients to those clinicians.
- If a patient has been seen by more than one clinician, determine if there is a clinician whom the patient has seen more than the others. If so, assign the patient to the most frequently seen clinician.
- If no particular clinician stands out for a patient, determine which clinician saw the patient for his or her last physical. Assign the patient to that clinician.
- If there is no recent physical for a patient, assign the clinician the person saw last.
- Incorporate the voice of the patient in this process as well. This can be done by training front office staff or the clinic’s call center to ask patients which clinician they see regularly and assign them as they register.
At the end of this process adjustments will have to be made to ensure that panel sizes are manageable. For example, a clinician who is new to the practice will have fewer patients assigned to his or her panel through this process than a clinician with a long tenure. You may need to help the practice align panel size with each clinician’s capacity, all the while keeping in mind patients’ preferences.
What Policies and Procedures Are Needed?
Processes need to be established in the practice to ensure the sustainability of managing patient panels over time. For example, training materials and job descriptions need to be established with panel management processes embedded within them. The Safety Net Medical Home Initiative also has a set of procedures that can guide your clinic in implementing guidelines to better suit the needs of the clinic. Available at: http://www.champsonline.org/ToolsProducts/CrossDiscResources/PCMH/PCMHPandPs.html.
Practices should develop a policy statement on panel management that covers topics such as changing providers, assigning new patients to providers, and staffing models to support providers based on the number of patients assigned to the panel. A sample of Policies and Procedures is contained in the Module 20 Appendix C.
How Does a Practice Monitor Empanelment?
Practices should monitor the effectiveness of their empanelment process on a regular basis and report to individual care teams and the practice as a whole. Suggested metrics are:
- Percentage of patient visits to their designated clinician.
- Percentage of patient visits to clinicians other than their designated clinician.
- Percentage of total patients unassigned to a panel.
- Size of panel by clinician and how it compares to target panel size for the practice.
- Percentage of patients who are new.
- Percentage of patients reassigned to another clinician.
- Number of overbooked appointments per week.
- An access measure, such as 3rd Next Available Appointment per clinician (the average number of days between a request for an appointment and the 3rd available appointment for that clinician—a more sensitive measure of true appointment availability).
- Patient satisfaction survey with specific questions on access and satisfaction.
- Staff satisfaction with empanelment process, including clinicians, other clinical staff, and office staff.