The impact of case mix on timely access to appointments in a primary care group practice

Area of Science:

• Primary Care Medicine
• Health Services Research
• Operations Research

Background:

• Physician panels are central to primary care, defining patient populations for holistic care.
• Panel size and patient case-mix significantly influence physician workload and appointment availability.
• Access to care in primary care settings is often constrained by patient demand exceeding provider capacity.

Purpose of the Study:

• To quantify the impact of physician panel size and case-mix on patient access in multi-provider primary care practices.
• To develop an optimization framework for managing physician panels to improve patient access.
• To provide a practical tool for primary care practices to assess and adjust panel composition.

Main Methods:

• Formulated the problem of minimizing maximum overflow (access measure) as a non-linear integer programming problem.
• Developed heuristic strategies for panel re-assignment based on structural insights from the optimization model.
• Utilized patient-level data from a primary care practice for methodology illustration and validation.

Main Results:

• Quantified the relationship between panel size, case-mix, and overflow frequency (access).
• Demonstrated that the optimization framework can identify imbalances across physicians.
• Showcased heuristic strategies that effectively improve access with minimal disruption.

Conclusions:

• The developed optimization framework provides a quantitative approach to panel management in primary care.
• This methodology enables practices to proactively address access issues stemming from panel imbalances.
• The approach is practical, implementable in tools like Excel, and supports strategic panel management decisions.