The Blueprint

PCMH panel size trends: Introducing a new data series

by Amanda Berra

Industry attitudes toward PCMH panel size have changed.  Early adopters of the medical home tended to believe that they had to reduce per-provider panel size as part of the practice transformation process to hit key PCMH goals such as:

  • Giving physicians and teams with enough time to complete transformation work
  • Improving quality of care (by enabling physicians to spend more time with each patient)
  • Ensuring the sustainability of clinician workload in the long term

Today, even though all these goals remain in force, PCMH transformations typically do not include panel size reductions.  This blog post, the first in a new series on panel size data and trends, examines the evolution in perceptions of the PCMH model's ability to support sustainable growth.  

Motivated to grow

At least two strategic goals drive organizations' decisions to make panel size expansion a central PCMH goal.

  • Better utilizing primary care capacity: For population management reasons, it is critical for health systems to extend primary care access to more patients across an entire population and find ways to work through capacity constraints, such as a shortage in PCPs.
  • Growing market share: For health systems, success in population management will mean fewer specialty/ED/acute care services per capita. Additionally, demographic shifts will increase the percentage of medical versus surgical procedures in the average acute care hospital across the coming decade. Together, these two forces make the capture, retention, and backfilling of new patients into the organization even more critical to financial stability.

Trust in the PCMH model is paving the way

The idea that the PCMH model can deliver sustainable panel size growth has a high bar of skepticism to overcome at the site level.  Clinicians have understandable concerns about increasing panel size, especially if their day-to-day experience of primary care delivery is that it is already high-volume, comparatively low-return, and "like spending all day on a crazy treadmill that you can’t turn off," as a few physicians have remarked over the years.

Over time, we have seen increasing levels of trust that the PCMH model actually can work to raise quality while also promoting efficiency and workload sustainability, making room for additional patients.   A critical mass of evidence from PCMH pioneers can be used to support this case, as long as key elements are demonstrably in place—such as top-of-license staffing, IT support systems, and team-based care.

How much, how fast?

Data from the Medical Home/Primary Care Benchmarking Initiative helps shed light onto how medical home organizations are working with panel size. The next posts in this series will provide additional data and analysis, but in short, most PCMHs in our sample have been PCMHs for an average of two years, kept panel sizes steady during their transformation process, and plan to grow—the average growth target across all different types of PCMH is to make per-provider panels about 20% larger by 2014.

Next in the PCMH panel size series

Over the coming weeks, we will share updated findings and data on panel size and growth trends in today’s PCMHs, highlighting data from the Medical Home Project's Medical Home/Primary Care Benchmarking Initiative.

  • Panel size theory and the PCMH: How does the model enable growth?
  • Data: What is the average number of patients per PCMH physician FTE?
  • Data: What factors predict bigger panel sizes at some PCMH sites?
  • Data: How much—and how fast—are PCMH sites planning to grow?
  • Provider satisfaction and workload sustainability in the PCMH

Please make sure you are subscribed to this blog (and/or following us on Twitter at www.twitter.com/AmandaBerra) to receive a notice when each piece in the series is added.