PHMI Community Health Centers (CHCs) lay the groundwork for population-based care by working on four “Building the Foundation” areas of focus: Data Quality & Reporting, Business Case, Care Teams and Workforce and Empanelment. Among these foundational areas, empanelment—a process that assigns patients to a primary care provider (PCP) and a care team with an aim of improving continuity of care and, ultimately, health outcomes for patients on a large scale—can be a particularly complex challenge, demanding significant organizational and cultural shifts.
ParkTree Community Health Center serves adults and children living in Pomona and Ontario, CA, and has achieved notable traction in their empanelment efforts, resulting from multiple attempts and lessons learned along the way. Their journey demonstrates how successful empanelment is a continuous improvement process requiring strategic investment in people, technology and a culture of open communication and accountability.
Below, ParkTree’s PHMI team members and their coach, Lindsay Lozada-Dietz, share experiences and insights for other CHCs navigating their own empanelment journeys.
- Lay the foundation, then ensure ongoing effort.
“We could tell when it wasn't really working because, as a provider, I would see everybody else's patients. I was like, 'Where are my patients?' It's finally starting to even out where I'm mostly just seeing my patients." — Suzan Shakhshir, FNP-C
The ParkTree team initially thought empanelment could be completed once—in other words, they would use the "four-cut method" and it would automate itself. Instead, the team found that their patient population is constantly changing, while external factors, such as changes in California's Medi-Cal expansion, continually impact their panel sizes and assignments. Frequent changes in provider schedules and locations also require constant patient reassignment. However, as Elvia Sanchez, COO, ParkTree, shared, “It takes a lot of work, but once you set up the foundation for it, it's a lot easier to continue the work.”
Lesson learned: In a dynamic healthcare environment, empanelment is not a “one and done” task—it’s a dynamic, ongoing process. Without a dedicated role and sustained effort, it is likely to stagnate, especially with changing patient populations and provider shifts.
- Designate a full-time role.
“We have around 12,000 patients… So even though it’s one person, it does take a full-time position. Our empanelment coordinator has really been able to clean up our empanelment.” – Jose Palacios, Director of Quality Improvement
Prior to creating a dedicated position for a full-time panel coordinator, ParkTree delegated empanelment responsibilities to existing staff. In one instance, their front desk supervisor was asked to monitor empanelment, and on top of their other tasks, it soon became unmanageable. Later, the team saw the value of the full-time role when it was vacant—empanelment effectiveness dropped sharply, even with support from the clinic flow manager. The panel coordinator has been instrumental in cleaning up data related to PCP assignments, ensuring that panels are open and accurately adding patients.
Lesson learned: As Sanchez reflects, "you just can't add that type or size of a task to a front desk manager who's already busy trying to manage all the sites." The decline in effectiveness when the dedicated position was lost further solidified the understanding that "you need that position. It's not easily manageable or added to somebody else’s role." By prioritizing consistent staffing, they can maintain momentum and continue progress.
- Invest in efficient data management and visualization.
ParkTree "didn't just focus on establishing the environment; they also built a dashboard that allows them to follow up and monitor the process for sustainability." – Lindsay Lozada-Dietz, Coach
In the past, ParkTree struggled with an incomplete view of their patient population because their electronic medical record only captured data from patients seen in their clinics, missing over 30 percent of assigned patients. Their reliance on older reporting tools led to constant, burdensome manual mapping and maintenance, which often became outdated, especially with staffing changes, and raised questions about data accuracy. Additionally, their dashboards were slow, taking up to an hour to refresh, which led to disconnects and hindered timely decision-making.
To overcome these challenges, they invested in implementing a system that aggregates data from diverse sources and automates matching and normalization of disparate data. It significantly reduces refresh time to a few minutes, enabling quicker responses to operational needs. By developing a more robust infrastructure for managing and visualizing empanelment data and ensuring frontline staff have access, the team can see in real-time which panels are open to more efficiently assign patients to PCPs and track continuity of care. The team is also able to leverage data to gain team buy-in and make data-informed decisions.
Lessons learned: ParkTree made a conscious decision to "invest the right resources into empanelment," according to Palacios. Ultimately, they found that data management and visualization are not just technical components; they are foundational elements that enable real-time operational efficiency, continuous monitoring of key performance indicators like continuity of care, and overall accountability in the empanelment process.
- Engage providers.
"The Daily Productivity dashboard, which our clinic managers and providers had access to, helped move that conversation along. We were able to view the data together day by day..." — Ofer Ho, CIO
The Panel Coordinator prioritizes provider engagement, providing education and ongoing support to frontline staff about empanelment. A recently implemented provider incentive plan also provides quarterly bonuses for exceeding productivity targets.
Because ParkTree providers are also able to access improved data dashboards, they are gaining a sense of ownership. During the May 2025 PHMI webinar on data visualization, Ho shared an anecdote in which there was contention between clinic managers and providers about whether patients who arrived late should be seen. Objective data from their dashboard showed that very few patients (less than 1 percent) were being turned away because they were late. “The data showed the impact of that decision was so minimal that we decided it wasn't even worth our while to continue the discussion, and the decision was left that the providers would make that call,” shared Ho.
Lesson learned: Along with improving provider’s sense of ownership and competence through training and incentives, ParkTree’s team used data to increase provider buy-in. Transparent, data-driven decision-making has the power to address provider concerns and, ultimately, optimize operations.
- Engage patients.
"Empanelment is an internal process, but it's bound to fail if not externalized. Patients need to know their PCP; if we don't tell them and put them front and center in our medical efforts, we won't succeed." - Ofer Ho, CIO
Sanchez states that, at one point early in their empanelment journey, "patients were going in different directions seeing different providers." Although a PCP was assigned in the system, the patient saw different providers. ParkTree now emphasizes informing patients about their assigned PCP and care team to “put the patient in the front and center." They also make their care team visible by posting a "tree" visual in exam rooms and brochures, and are planning to provide educational events for patients to get a better understanding of the importance of having an assigned PCP.
Lesson learned: When patients are not consistently seeing their assigned PCP despite internal assignments, it is essential to close the gap between internal processes and patient experience. By using educational materials for patients and training medical assistants to proactively communicate about care teams, empanelment can become an externalized, patient-facing process.
- Encourage a culture of improvement.
"As we discuss various items in our operational meetings, we come up with additional data needs, and the team helps me design those dashboards. I can provide them with a line graph, but then my CFO might say, 'Well, that doesn't tell the story. Can you change it for this?'" — Ofer Ho, CIO
In weekly operations meetings, the team reviews data from various dashboards to identify priorities with executives. This collaborative environment extends to co-creating solutions, where the team helps design and refine dashboards to highlight key insights. As described by coach Lozada-Dietz, this demonstrates their strong multi-disciplinary, multi-level team and excellent communication channels. In part, she attributes success to their “one hundred percent honest and upfront” communication, even when discussing challenges.
Lesson learned: A communicative team combined with strong leadership and a genuine "culture of improvement" has resulted in rapid progress in ParkTree’s empanelment journey. The willingness to have crucial, and sometimes uncomfortable conversations helps the team effectively address challenges and continue moving forward.