Capacity Allocation and Flexibility in Primary Care

Hari Balasubramanian (), Ana Muriel (), Asli Ozen (), Liang Wang (), Xiaoling Gao () and Jan Hippchen ()
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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

Chapter Chapter 8 in Handbook of Healthcare Operations Management, 2013, pp 205-228 from Springer

Abstract: 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.

Keywords: Primary Care Provider; Timely Access; Primary Care Practice; Capacity Allocation; Panel Size (search for similar items in EconPapers)
Date: 2013
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DOI: 10.1007/978-1-4614-5885-2_8

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