Empanelment Resource 9:

Reports Necessary for Ongoing Empanelment

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This resource is part of the Empanelment Implementation Guide, offering steps and activities to help your practice select and implement a methodology to create patient panels and develop continuity reports. It is the second in the “Building the Foundation” series of implementation guides.

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The following reports support sustained empanelment. Core reports are critical to initial empanelment implementation. Once the core reports are being run consistently and acted upon, then advanced empanelment reports should be tackled.

FIGURE 9.1: REPORTS AND FREQUENCY


Priority
Report Domain
Report Description
Frequency of Report

Core Reports
Continuity (Provider Perspective)
Percent of providers’ appointments that are with patients who are on their panel.
Monthly

Continuity (Patient Perspective)
Percent of patients’ appointments (all or specific type) that are with the PCP they are empaneled with.
Monthly

Third Next Available Appointment (TNAA)
Average length of time in days between the day a patient makes a request for an appointment with their PCP and the TNAA for a new patient physical, routine exam or return visit exam.
Semi-annually for empanelment purposes (used to assess and adjust weighting system)

Availability of Same-Day Appointments
Number of same-day appointment slots available for routine visits in a given time period (e.g., 30 days).

Use of Same-Day/Next-Day Appointments
Number of filled appointment slots of a specific appointment type in a given time period (e.g., 30 days).

Count of Patients by PCP and/or PCP Teams
Total number of patients assigned to the provider.
Ad hoc

PCP Changes
Total number of patient PCP change requests per 1,000 empaneled patients by provider.
Monthly

Advanced Reports
Weighted Panel

Sum of all weights of patients (most universally expressed as percentage of FTE and, when expressed as such, is a panel resource projection).


Monthly to adjust new patient slots

Assignment Discrepancies
Patient assigned but not seen by the practice.
Ad hoc for improvement efforts with health plan

Patient assigned but seeing a PCP not in the CHC

Patient empaneled but assigned to a PCP not in the CHC.

Patient is assigned by the health plan to a PCP other than the empaneled provider at the CHC.

Retention (Newborns)
Number of children between 13 months and 15 months who had a visit within last four months.
Monthly

Retention (Pregnant Patients, Post-Delivery)
Patients with a delivery 91 to 122 days prior with a visit in last 90 days.
Monthly

Patients with Diabetes
Number of empaneled patients with diabetes seen 548 days (18 months) to 365 days (one year) prior also seen within last four months OR with two controlled A1cs in the last 12 months and one of those A1cs in last six months.
Monthly

Expected High-Visit Frequency Patients (High-Risk Patients)
Expected high-frequency visit patients (expected to have frequent visits, i.e., multiple expected high visit frequency patient conditions).
Monthly

Overall Retention
Empaneled and engaged at a time in the past AND currently empaneled and engaged in a more recent time window.
Every six months

Attribution
Discrepancies
Identifies specific patient/PCP associations, which are not consistent with the attribution algorithm.
TBD

Identifies patient/PCP associations not consistent with CHC administrative rules.
TBD

FIGURE 9.2: SPECIFICATIONS FOR RECOMMENDED REPORT MEASURES LISTED IN FIGURE 9.1


Domain
Report
Numerator
Denominator
Notes

Continuity, provider perspective
Appointments: Percent of providers’ appointments that are with patients who are on their panel
Number of appointments with patients on their panel at the time inclusive of no-shows (note: “at the time” means on the panel the day of appointment, as opposed to the day the report is run).
Number of appointments.
Fundamental report, as this measures staff processes to maintain continuity. Needed ability to generate report by patient characteristics (e.g., age range, condition, race, ethnicity, gender) and drill down to individual patient/appointment.

Visits: Percent of providers’ visits that are with patients who are on their panel
Number of visits with patients who are on their panel (rendering provider, no matter who the patient is scheduled with; does not count no-shows because no rendering provider).
Number of visits.
Can be important to reveal problems such as call-ins, over scheduling, or other routing of patients from scheduled provider.

Continuity, patient perspective
Percent of patients’ appointments (all or specific type) that are with the PCP they are empaneled with
Number of appointments of certain type(s) with empaneled PCPs (and separate PCP teams).
Number of appointments of certain type(s) (and separate PCP teams).
Some PCPs may have high continuity from their own perspective, and yet their patients have a hard time getting in to see them. Important for provider communications.

Access
Third next availableappointments (TNAA)
Average length of time in days between the day a patient makes a request for an appointment with their PCP and the TNAA for a new patient physical, routine exam or return visit exam.

Availability of same-day/next-day appointments
Number appointment slots of specific appointment type in time period (e.g., 30 days)
FTE of provider.

Use of same-day/next-day appointments
Number of filled appointment slots of specific appointment types in a time period (e.g., 30 days).
Number of appointment slots of specific appointment type in time period (e.g., 30 days).

Panel Size
Count/list of patients by PCP and/or PCP Teams
Drill down to individual patients.

Weighted Panel Size
Sum of all weights of patients (most universally expressed as percentage of FTE and, when expressed as such, is a panel resource projection).
Drill down to individual patients to see contribution to weight in panel. Weighting by various factors: age, weight, conditions, time since last activity versus expected, language congruence, etc.

Panel Resource Projections Retention
FTEs of Given Resource Needed for Panel
Sum of all time needed for defined programs based on empaneled patients’ attributes.
Drill down to individual patients.

Newborns
Number of children in denominator who had a visit within last four months with CHC.
Number of children between 13 months and 15 months of age who had a visit with CHC within 30 days of birth.
Produce run chart to assess rate change over time and/or return an average value over time periods (e.g., monthly).

Pregnant Patients, Post Delivery
Patients with a delivery 91 to 122 days prior with a visit in last 90 days.
Patients with a delivery 91 to 122 days prior.

Patients with Diabetes
Number of empaneled patients with diabetes seen 548 days (18 months) to 365 days (one year) prior also seen within the last four months (OR with two controlled A1cs in the last 12 months and one of those A1cs in last six months).
Number of empaneled patients with diabetes seen 548 days (18 months) to 365 days prior.

Expected High-Frequency Visit Patients (Expected to Have Frequent Visits, e.g., Multiple Chronic Conditions)
Number of empaneled patients with expected high-frequency visits seen 548 days (18 months) to 365 days (one year) prior and also seen within last four months.
Number of empaneled patients with expected high visit frequency seen 548 days (18 months) to 365 days prior.
CHC can define “expected high-frequency visit” such that the patients in the population would be expected to have a visit within four months.

Overall Retention
Empaneled & engaged.
Empaneled and engaged at a time in the past.
Establish a time period in which a patient must be actively using care in order to meet the definition of engaged and empaneled (e.g., 24 months prior).

Discrepency
Assignment Discrepancies
Assigned but not yet seen.
Filterable by future appointment, past no-show for an appointment, and contact status (unable to locate, UTL or has been contacted but does not have an appointment).

Assigned but seeing PCP not in CHC.

Empaneled but assigned to PCP not in CHC.

Health plan assignment is to a PCP at CHC other than empaneled PCP.
Assigned provider not match empaneled provider (not useful short term).

Attribution Discrepancies
Identifies specific patient/PCP associations, which are not consistent with the attribution algorithm.

Administrative Rules Discrepancies
Identifies patient/PCP associations not consistent with CHC administrative rules.
Main example: Patients are often disempaneled after a period of time, meaning the same PCP might no longer be a choice if they return after disempanelment.

Care Experience Evidenced by Panel Data
PCP Change Requests
Change requests per FTE per year.
Rates at health center, groups, and individual PCPs.