Building the Foundation

Empanelment Guide

Version 3 – June 2026

Going Deeper

Connecting Empanelment with Patient-Centered Access

Patient-centered access requires balancing both prompt availability of services and continuity with the patient’s own care team. Like empanelment, patient-centered access is an important building block of high functioning primary care[1] and is significantly impacted by the forces of supply and demand. Long waits for appointments cause delays in diagnosis and treatment, and may undermine patient satisfaction and perceptions of quality. While providers can improve access by scheduling patients with any available provider, relational discontinuity diminishes trust and the establishment of healing relationships.[2]

With a set of linked strategies, practices can successfully manage supply, demand and continuity using both empanelment and access tools. Strategies for success will depend on engaged leadership, adequate business intelligence resources and a systematic approach to monitoring and intervention on metrics relating to both promptness and continuity.

There may be times when practices must restrict access to new patients when the needs of established patients exceed the supply of provider time. Closing panels to new patients is often troubling and deeply countercultural for practices. This is especially true for health centers that have always operated with a mandate to serve everyone, regardless of their circumstance. While closing panels to manage the balance of supply and demand may cause heartburn in safety net practices, excessively large panels will also cause many familiar problems, including:

  • Discontinuity and disruption to relational care.
  • Long waits for appointments.
  • Patient attrition.
  • Provider burnout.

For a variety of reasons, many practices have struggled with the demand for primary care exceeding supply. They have adopted a range of strategies for addressing this imbalance, which include new technologies and formats for delivering care, care team enhancement to increase supply, and patient engagement strategies to reduce unnecessary demand. Practices have also been on the leading edge of many innovations to primary care delivery and have made bold investments to enhance the efficiency of care. This webinar from PHMI, Creating Access: How to Optimize Clinic Capacity to Engage Patients in Care, explores approaches to balance patient access with operational realities as practices aim to bring in patients who are due for care without overwhelming staff or clinic resources.

As all of these efforts improve efficiency and access to care, panel sizes can increase accordingly. Some practices have also addressed excess demand by creating separate care settings dedicated to providing episodic care, such as some school-based practices and urgent care centers rather than continuity-based empanelment care. In some cases, these strategies may even improve quality measure outcomes.[3] While episodic care may serve as a complement to an empaneled primary care environment, the population health benefits of continuity on costs, utilization, quality and experience require a sustained commitment to empanelment.[4], [5], [6], [7], [8], [9], [10], [11]

For wide-ranging access improvement ideas and implementation strategies, take a look at the Safety Net Medical Home Initiative Enhanced Access Implementation Guide.

Assigned Managed Care Members Not Yet Seen By the Practice

Managed care plan (MCP) members who have been assigned to the practice, but have not yet engaged as patients, are an important population to consider for empanelment. As patients assigned to the practice for primary care, these assigned-but-not-yetseen patients are included in the population basis for MCP capitated payment and P4P programs. Practices should consider how to account for these assigned-but-not-yet-seen patients in the attribution and empanelment process, including working proactively with contracted MCPs (or Independent Practice Association delegates) to reassign these patients when they are identified as receiving primary care elsewhere, have moved away, or are deceased.

Although this population has, by definition, not yet been seen by the practice, some members of this population will have primary care needs in the coming year and should be accounted for in PCP panels using a weighting strategy to adjust for their engagement status. Most practices do not empanel individual assigned-but-notyet-seen patients until contact. In order to establish an estimate of capacity based on assigned patients, add the aggregate weight of the assigned-but-not-yet-seen population to the aggregate of all providers’ panels to determine how full panels are for the practice as a whole. In many cases, practices find that they are at or near their capacity to accept new patients. However, depending on their agreements with the health plans, it is important for practices to make a proactive plan to build their capacity to accommodate assigned-but-not-yet-seen health plan members in the clinic.

In addition to accounting for the assigned-but-not-yet-seen patients in the empanelment process, practices should also develop strategies for outreach and engagement with these populations in order to shift them from not yet seen to fully engaged in primary care.[12] Potential outreach strategies include using community information exchange and health information exchange platforms to identify and learn about members of the assigned-but-not-yet-seen populations for outreach and engagement, as well as deploying expanded care team members, such as community health workers and peer support specialists, who may have enhanced community knowledge, relationships and engagement expertise.[13],[14] Practices can use the Outreach Planning Worksheets and Protocol Template to establish their process for how attributed patients (both seen and unseen) are contacted, with roles/responsibilities and areas of improvement that the population health team can advance over time.

Of course, the quality of data provided by health plans on the assigned-but-not-yet-seen health plan members can greatly hamper or facilitate these outreach efforts. Ongoing work to improve the data sharing and partnership between managed care plans (MCPs) and practices is critical. See the Data Quality and Reporting Guide, Key Activity #5: Identify and acquire external data for more.

Endnotes

  1. Bodenheimer T, Ghorob A, Willard-Grace R, Grumbach K. The 10 building blocks of high-performing primary care. Ann Fam Med. 2014;12(2):166-71.1. 
  2. Schwarz D, Hirschhorn LR, Kim JH, Ratcliffe HL, Bitton A. Continuity in primary care: a critical but neglected component for achieving high-quality universal health coverage. BMJ Glob Health. 2019;4(3):e001435. 
  3. Reid RJ, Scholes D, Grothaus L, Truelove Y, Fishman P, McClure J, et al. Is provider continuity associated with chlamydia screening for adolescent and young adult women? Prev Med. 2005;41(5-6):865-72. 
  4. Gray DJP, Sidaway-Lee K, White E, Thorne A, Evans PH. Continuity of care with doctors—a matter of life and death? A systematic review of continuity of care and mortality. BMJ open. 2018;8(6):e021161. 
  5. Raddish M, Horn SD, Sharkey PD. Continuity of care: is it cost effective? Am J Manag Care. 1999;5(6):727-34. 
  6. Sabety AH, Jena AB, Barnett ML. Changes in Health Care Use and Outcomes After Turnover in Primary Care. JAMA Intern Med. 2021;181(2):186-94. 
  7. Schafer WLA, Boerma WGW, van den Berg MJ, De Maeseneer J, De Rosis S, Detollenaere J, et al. Are people’s health care needs better met when primary care is strong? A synthesis of the results of the QUALICOPC study in 34 countries. Prim Health Care Res Dev. 2019;20:e104. 
  8. Matulis JC, 3rd, Schilling JJ, North F. Primary Care Provider Continuity Is Associated With Improved Preventive Service Ordering During Brief Visits for Acute Symptoms. Health Serv Res Manag Epidemiol. 2019;6:2333392819826262. 
  9. Brousseau DC, Meurer JR, Isenberg ML, Kuhn EM, Gorelick MH. Association between infant continuity of care and pediatric emergency department utilization. Pediatrics. 2004;113(4):738-41. 
  10. Nyweide DJ, Anthony DL, Bynum JP, Strawderman RL, Weeks WB, Casalino LP, et al. Continuity of care and the risk of preventable hospitalization in older adults. JAMA Intern Med. 2013;173(20):1879-85. 
  11. Arthur KC, Mangione-Smith R, Burkhart Q, Parast L, Liu H, Elliott MN, et al. Quality of Care for Children With Medical Complexity: An Analysis of Continuity of Care as a Potential Quality Indicator. Acad Pediatr. 2018;18(6):669-76. 
  12. El Sol Neighborhood Education Center. Effective Community Outreach Strategies. San Bernardino: El Sol; August 18, 2022 [September 11, 2023]. Available from: https://www.elsolnec.org/blog/2022/08/18/effective-community-outreach-strategies/. 
  13. Center for Health Care Strategies. Recognizing and Sustaining the Value of Community Health Workers and Promotores. Hamilton, NJ: CHCS; January 2020 [September 11, 2023]. Available from: https://www.chcs.org/resource/recognizingand-sustaining-the-value-of-community-health-workers-and-promotores/. 
  14. Harris RA, Campbell K, Calderbank T, Dooley P, Aspero H, Maginnis J, et al. Integrating peer support services into primary care-based OUD treatment: Lessons from the Penn integrated model. Healthc (Amst). 2022;10(3):100641.