First, design standard APP roles that support organizational—not individual physician—goals. This means moving from physician-driven pilots to more codified roles that align to the metrics that matter most to group success.

Align APP role with organizational goals

You won’t use APPs the same way in every practice or specialty. But the decision about whether and how to deploy an APP should be removed from individual physicians and elevated to the practice-, specialty-, group-, or even system-level. Just as physician hiring, recruitment, and deployment is centralized to support the organization’s larger strategy, the same should hold true for APPs.

Organizations predominantly deploy APPs to support three common goals:

Three goal-driven deployment models

While organizations most commonly deploy APPs to expand access, these providers are often an untapped resource for advancing population health goals. Given their background in patient education, APPs are well-suited to manage more complex patients when provided with adequate care protocols and training.

In addition, while APPs building out their own panels is mostly limited to rural markets and primary care for now, we expect APP-only panels and practices to become more ubiquitous in the future, providing organizations who act now with a first mover advantage.

Clearly defining APP ROI

Beyond designing roles that advance strategic goals, teams must be held accountable for how they deploy their APPs. While some local variation is expected, wide variation in roles shouldn’t exist across the organization.

Organizations should establish mechanisms that reinforce standard APP roles. One way to do this is by clearly defining metrics of success prior to hiring and deploying APPs—and holding teams accountable for meeting them. For example, some organizations set a baseline productivity target that the care team must meet. Others require that practices submit a full business case to justify hiring another APP. Setting a group standard like this reinforces the business objective for deploying APPs and ensures that leaders see ROI.

Most leaders would agree that there’s a gap between the skills APPs graduate with and those they need to practice autonomously. While physicians receive additional training via residencies and fellowships following medical school, these programs are rare for APPs. To equip APPs to take on autonomous roles, organizations must provide this supplemental training themselves.

Organizations should take a centralized approach to prepare APPs for provider roles in two key areas: group onboarding and clinical training.

Combine physician and APP onboarding

Rather than develop two separate programs, onboard your physicians and APPs together. As APPs take on roles more similar to physicians, onboarding them together better sets expectations for your provider workforce as a whole on important topics such as group culture and workflow processes. To incorporate APPs into your existing program, use the same curriculum and timeline, but pair APPs with APP mentors and physicians with physician mentors.

Greater investment needed in clinical training

While organizations can incorporate APPs into existing physician onboarding programs, recently graduated APPs require additional training on clinical skills not needed by newly hired physicians. Often, this clinical training is left to individual physicians. While leaders often believe that physicians are best equipped to train APPs given their clinical expertise, physician-led training is often resource-intensive and inconsistent.

Instead, leaders should invest in an organization-wide approach for training APPs to streamline physician workload and ensure more consistent skill development. While the exact model varies by organization, there are four key components of any successful APP training program:

• Scaled training program: Train APPs in an organization-wide program, not by individual physicians.
• Defined core and specialty competencies: Determine the skills and knowledge APPs must demonstrate.
• Personalized skill-gap analysis: Tailor training to the areas where APPs need the most support.
• Standardized signoff process: Create an objective process for assessing APP readiness to practice autonomously.

Most APPs today are paid on a flat salary—with little or no bonus potential. Not only does this compensation approach fail to reward APPs for their contributions to group success, but it doesn’t incentivize them on key performance indicators like productivity, quality, or patient experience that’s expected from providers.

Shift APPs towards physician-like compensation

Organizations must pay their APPs like they do their physicians: on a performance-based compensation model. At a minimum, APPs should be paid a base salary with bonus potential. While bonus size may vary, all APPs should have some compensation tied to non-productivity metrics and be evaluated on the same metrics as physicians (e.g., patient experience, quality).

We’re starting to see some organizations shift APP compensation to more closely mirror physician compensation—for example, paying providers a base salary linked to productivity, tying APP compensation to group performance metrics, and distributing shared savings to APPs.

Regardless of your specific organization’s compensation model, compensation for APPs should look more like how you pay your physicians, not other staff or care team members. Not only does this more appropriately incentivize APP performance, but it better sets expectations and shared goals for your entire provider workforce.

Despite investments in standardized deployment, centralized training, and performance-based compensation models, organizations will fail to maximize APP autonomy without involving them in governance. Representation in leadership roles ensures that APPs feel valued—improving their engagement and reducing turnover.

APP councils commonplace at most organizations

Most organizations start by creating an APP council. Not only does this make APPs feel like they have a dedicated forum to provide input, but it also empowers them to address concerns that are specific to APPs, like credentialing and scope-of-practice. Invite APPs from across the organization to serve on the council to ensure that diverse perspectives are represented.

Hiring a senior APP leader is the new baseline

While forming a council is a good entry point, by now, most organizations should already employ a dedicated APP leader to spearhead their larger APP strategy. Though frontline APPs may not have a direct reporting line to the lead APP, this leader should oversee the organization’s entire APP enterprise, including the components discussed in this report, such as deployment, training, and compensation. As APPs become a growing percentage of the workforce, a leader like this becomes even more essential to spearhead strategy moving forward. Just as important, however, elevating an APP in this way is engaging to those on the frontlines.

Integrating APPs into organizational leadership

But it isn’t enough to just create separate APP leadership structures. To fully realize their potential, leaders must integrate APPs into existing governing bodies as well. Not only does this move convey important signal value, but APPs often bring a different, valuable perspective to strategic conversations.

Inviting APPs to sit on committees is a good starting point—especially in areas where they have a growing impact such as quality, patient experience, and referral strategy. But APP involvement can’t stop here.

Just like physicians, leaders must give APPs a seat at the table, fully integrating them into strategic governing bodies and providing them with appropriate representation. We’re starting to see organizations elevate APPs to positions on boards and executive teams. Progressive groups are even adjusting the composition of leadership bodies to better reflect the proportion of APPs and physicians in their provider workforce. Again, the signal value is key, but just as important is the APP perspective, especially as they become even more central to the organization’s success.