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Capacity Allocation and Flexibility in Primary Care

In: Handbook of Healthcare Operations Management

Author

Listed:
  • Hari Balasubramanian

    (University of Massachusetts)

  • Ana Muriel

    (University of Massachusetts)

  • Asli Ozen

    (University of Massachusetts)

  • Liang Wang

    (University of Massachusetts)

  • Xiaoling Gao

    (University of Massachusetts)

  • Jan Hippchen

    (University of Massachusetts)

Abstract

We discuss capacity allocation for primary care practices at three different planning levels: the strategic, the tactical and the operational. The goal in each case is to maximize two important but often conflicting metrics: (1) timely access and (2) patient-physician continuity. Timely access focuses on the ability of a patient to get access to a physician as soon as possible. Patient-physician continuity refers to building a strong relationship between a patient and a specific physician by maximizing patient visits to that physician. Each primary care provider (PCP) has a panel of patients for whose long term holistic care the PCP is responsible. At the highest or strategic level, the design of physician panels, we demonstrate the impact of case-mix, or the type of patients in a physician’s panel, and show how panels can be redesigned effectively. Panel redesign, however, involves changing existing patient-physician relationships. A viable alternative is managing the inherent flexibility of PCPs to see patients of other physicians. At the tactical level, this requires allocating the flexible capacity to two types of appointments: 1) prescheduled appointments which are booked in advance and require continuity; and 2) same-day appointments. Using a 2-stage stochastic optimization model, we show that greedy algorithms find the optimal capacity allocation, and find that a partially flexible practice provides a good compromise between timely-access and continuity. Finally, at the operational level, the implementation of flexibility during a workday has to be made under partial demand information, as patient calls arrive over the course of a day. We discuss the impact of flexibility and suggest heuristics that practices can use in this dynamic case.

Suggested Citation

  • Hari Balasubramanian & Ana Muriel & Asli Ozen & Liang Wang & Xiaoling Gao & Jan Hippchen, 2013. "Capacity Allocation and Flexibility in Primary Care," International Series in Operations Research & Management Science, in: Brian T. Denton (ed.), Handbook of Healthcare Operations Management, edition 127, chapter 0, pages 205-228, Springer.
  • Handle: RePEc:spr:isochp:978-1-4614-5885-2_8
    DOI: 10.1007/978-1-4614-5885-2_8
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    Citations

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    Cited by:

    1. 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.
    2. Lara Wiesche & Matthias Schacht & Brigitte Werners, 2017. "Strategies for interday appointment scheduling in primary care," Health Care Management Science, Springer, vol. 20(3), pages 403-418, September.
    3. Hao-Wei Chen, 2023. "Managing a multi-panel clinic with heterogeneous patients," Health Care Management Science, Springer, vol. 26(4), pages 673-691, December.

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