What is patient panel optimization and what are the benefits?

Patient panel optimization refers to the strategic management of the number and types of patients assigned to a healthcare provider to ensure optimal care delivery. This process involves balancing the workload among providers, considering factors such as care team model, patient complexity, provider capacity, provider experience, and available resources.

The definition of patient panel optimization has evolved over the years, expanding from primary care to include specialist care. This expanded definition offers a more holistic approach by ensuring that all aspects of patient care, including outpatient visits, procedures, surgeries, and inpatient stays, are aligned.

Patient panel optimization comes with a variety of benefits. For providers, it creates a more manageable workload, reduces burnout, improves job satisfaction, and ensures that providers have the required time to adequately care for their patients. Not only does having the correct risk-adjusted panel size allow providers to understand the makeup of their patient panel, but it also leads to more accurate schedule templates and an appropriate number of new patient openings, which promotes panel size maintenance. Collectively, these benefits help meet work relative value units (wRVU) targets and inform when to open and close panels.

For patients, panel optimization enhances access to care, reduces wait times, increases patient satisfaction, and ultimately improves health outcomes. For the healthcare system, on the other hand, patient panel optimization leads to a more efficient use of resources, better patient flow, and happier providers.

4 key factors in patient panel optimization

Several factors influence patient panel optimization:

• Determining the appropriate panel size is critical since panel size directly impacts the provider’s ability to see patients and manage their care effectively. To do this effectively, organizations must take into consideration the provider's care team model, experience, current capacity, the complexity of patient needs, and the available support resources.
• Risk adjustment is also essential to ensure alignment between panel complexity and time allocated to see patients. This involves using risk scores and other metrics to determine the appropriate panel size target for a provider given historical patient complexity. The panel size is then translated to a schedule that allows providers to meet targets. When done well, providers have a more manageable workload and are less likely to burn out.
• The structure of the care team, including the roles of nurse practitioners, physician assistants, and other support staff, plays a significant role in patient panel optimization. Care team design must be tailored to the specific needs of the patient population and the capabilities of the providers. Design should be thoughtful, promote top of license activity, and clearly articulate roles and responsibilities of each member of the care team.
• Scheduling templates are another crucial factor, ensuring that providers have the right number of slots and new patient appointment session limits. A provider that has exceeded panel size targets would have a schedule that limits new patient visits, while a provider that is growing their panel would have fewer or no restrictions. This maximizes throughput, efficiency, and patient access.

Potential challenges and how to overcome them

Implementing patient panel optimization comes with several challenges:

• Gaining provider buy-in is crucial for successful implementation. Without the support and engagement of healthcare providers, any optimization efforts are likely to face resistance and may not succeed. Any management structure needs to be carefully designed to focus on the unique needs of either the medical group or the independent physician group. Providers with leadership capabilities, partnered with administrative counterparts, are essential to a strong management structure.
• Accurate data is essential for risk adjustment and panel size determination. Ensuring that providers document patient information thoroughly and use the correct codes over a long enough period of time is critical to accurately portraying panel size risk. Additionally, accuracy of the providers’ clinical full-time equivalent (cFTE) is foundational to determining risk-adjusted panel size targets.
• Proper resource allocation, including support staff and technology, is necessary to enable optimized panels. Failing to allocate resources effectively can hinder the success of optimization efforts.
• Change management can be another significant hurdle. Careful planning and communication are needed to manage the transition to optimized panels, minimize disruption, and ensure a smooth implementation.

How to implement patient panel optimization and measure success

Successful implementation of patient panel optimization involves several steps:

1. Validate cFTE and patient-facing hours
2. Choose a baseline model to determine risk
3. Define care team models
4. Set panel size targets based on risk and other critical factors
5. Overlay productivity and schedule analysis to determine template and care team model design
6. Review on a quarterly basis

The first step is to conduct a thorough assessment of cFTE, current panel sizes, patient complexity, provider capacity, and wRVU production.

In addition, developing a detailed plan for optimization, including risk adjustment and care team design, is also essential. Similarly, engaging providers and support staff in the process and providing training on new workflows and expectations is necessary for gaining buy-in and ensuring smooth implementation. Rolling out the optimized panels in phases can allow time for adjustments based on feedback and performance metrics.

Lastly, continuous monitoring and evaluation is needed to ensure the optimization efforts are achieving the desired outcomes. Examples of metrics to monitor include access to care, provider workload, and patient outcomes. Using the collected data to make ongoing adjustments and improvements will go far in helping organizations achieve long-term success.

Examples of success in patient panel optimization

Several healthcare organizations have worked with Optum Advisory and prioritized defining panel sizes within their medical groups. One Optum Advisory client on the West Coast implemented a risk-adjusted panel size model for primary care providers. By aligning patient panel size ranges to provider risk scores, they improved access to care and helped to ensure providers with more complex patients were not overloaded with a patient volume exceeding their capacity.

Similarly, another Optum Advisory client integrated patient panel optimization into their specialty care services. By adjusting panel sizes and scheduling templates, the client was able to manage to its third-next-available appointment targets, improve provider satisfaction, and develop a protocoled model of accepting new patient referrals. The panel size determinants drove appropriate assignment of new patients to providers who had capacity to accept new patients of varying complexity.

Conclusion

Patient panel optimization is a vital strategy for enhancing patient care and provider satisfaction. By carefully managing panel sizes, adjusting for patient risk, and designing effective care teams, healthcare organizations can improve access to care, reduce provider burnout, and achieve better health outcomes.

While implementing patient panel optimization requires careful planning, engagement, and ongoing monitoring, the benefits are well worth the effort.