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

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  • Asli Ozen
  • Hari Balasubramanian

Abstract

At the heart of the practice of primary care is the concept of a physician panel. A panel refers to the set of patients for whose long term, holistic care the physician is responsible. A physician’s appointment burden is determined by the size and composition of the panel. Size refers to the number of patients in the panel while composition refers to the case-mix, or the type of patients (older versus younger, healthy versus chronic patients), in the panel. In this paper, we quantify the impact of the size and case-mix on the ability of a multi-provider practice to provide adequate access to its empanelled patients. We use overflow frequency, or the probability that the demand exceeds the capacity, as a measure of access. We formulate problem of minimizing the maximum overflow for a multi-physician practice as a non-linear integer programming problem and establish structural insights that enable us to create simple yet near optimal heuristic strategies to change panels. This optimization framework helps a practice: (1) quantify the imbalances across physicians due to the variation in case mix and panel size, and the resulting effect on access; and (2) determine how panels can be altered in the least disruptive way to improve access. We illustrate our methodology using four test practices created using patient level data from the primary care practice at Mayo Clinic, Rochester, Minnesota. An important advantage of our approach is that it can be implemented in an Excel Spreadsheet and used for aggregate level planning and panel management decisions. Copyright Springer Science+Business Media New York 2013

Suggested Citation

  • Asli Ozen & Hari Balasubramanian, 2013. "The impact of case mix on timely access to appointments in a primary care group practice," Health Care Management Science, Springer, vol. 16(2), pages 101-118, June.
  • Handle: RePEc:kap:hcarem:v:16:y:2013:i:2:p:101-118
    DOI: 10.1007/s10729-012-9214-y
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    References listed on IDEAS

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    Cited by:

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    7. Hessam Bavafa & Sergei Savin & Christian Terwiesch, 2021. "Customizing Primary Care Delivery Using E‐Visits," Production and Operations Management, Production and Operations Management Society, vol. 30(11), pages 4306-4327, November.
    8. Ahmadi-Javid, Amir & Jalali, Zahra & Klassen, Kenneth J, 2017. "Outpatient appointment systems in healthcare: A review of optimization studies," European Journal of Operational Research, Elsevier, vol. 258(1), pages 3-34.
    9. Masoud Kamalahmadi & Kurt M. Bretthauer & Jonathan E. Helm & Alex F. Mills & Edwin C. Coe & Alisa Judy-Malcolm & Areeba Kara & Julian Pan, 2023. "Mixing It Up: Operational Impact of Hospitalist Caseload and Case-Mix," Management Science, INFORMS, vol. 69(1), pages 283-307, January.

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