Empanelment Guide

These key activities offer a concise set of tasks that your practice can work through to initiate or improve a sustainable, data-driven and person-centered approach to empanelment. You may already have completed some of these activities, in which case you can start wherever makes the most sense to you. You may also find that some of these tasks are iterative, and will need to be revisited over time as you develop systems to not only launch but also sustain a practice-wide approach to empanelment.

The key activities below will guide you through the process:

1. Invest in role clarity, leadership engagement and staff participation.
2. Develop data and reporting capabilities to implement and manage empanelment and panel data.
3. Conduct initial patient assignment and supply and demand balancing.
4. Develop ongoing strategies for managing empanelment and population health.

After working through the key activities, you will be able to:

• Identify a panel manager.
• Conduct initial patient assignment and balance supply and demand.
• Implement ongoing panel management by regularly monitoring empanelment reports and making panel adjustments.

While at first glance empanelment might seem like a set of technical and formulaic activities for population segmentation and attribution, successful execution requires far more than rendering clear designations in the clinical information system. Empanelment can drive the primary care paradigm from reactive care provided to individual patients to proactive, accountable care provided at the population level; actualizing this paradigm shift requires strong leadership and the involvement of all the critical stakeholders, from patients to providers, care teams and data analytics partners.

1. Assign responsibilities for managing empanelment to a new or existing leader with a clear description of duties.

• Centralize operational leadership of the empanelment process by designating an individual to be the panel manager. The panel manager may be a newly hired role, or these duties may be added to an existing and well suited role. See below for key responsibilities for empanelment operational leadership.
• Position the panel manager with adequate authority to collaborate with senior leaders to define and guide empanelment strategy within the organization, as well as with data and HIT leaders to provide panel data for care teams to drive population health management.
• Prioritize and integrate empanelment data such as overall empanelment rate, continuity, panel size variation and appropriate schedule utilization into the organization’s performance dashboard for routine reporting and improvement.

The person assuming these duties may vary depending on practice size and organizational structure. This role could be fulfilled by a director of quality improvement, a data analyst or a project manager.

Suggested responsibilities for the empanelment leader:

• Generate periodic reports for key performance indicators (KPIs) such as continuity, retention and PCP changes.
• Generate operational reports such as clinician capacity (panel fullness), urgent/ same-day appointment availability, and third next available appointment (TNAA).
• With operations leader(s), ensure that the number of new patient slots align with the degree of panel fullness.
• With operations and medical leaders, create PCP teams and care teams.
• With medical leadership, review PCP change requests to ensure patients understand their role in PCP choice and that their reasons for excess change requests are understood and addressed.
• Educate all staff and providers on the importance of empanelment, access and continuity.
• Assess the impact of requests for changes in part-time status for clinicians.
• Assess the impact of and support medical and operational leaders in making decisions on cross coverage, temporary coverage, and movement of whole or partial panels.
• Manage panel weighting activities.

2. Proactively engage providers and teams as partners in the empanelment process.

Empanelment and panel management in a primary care practice substantially reorganizes the practice’s approach to service delivery and requires staff participation and proactive change management to succeed. Check out the Supporting Change section for additional tips on change management for empanelment.

A clear communication, engagement and education strategy to facilitate primary care provider and care team participation in the empanelment process is critical for organizational success. Involving PCPs and care team members in the organizational approach to empanelment drives a sense of ownership for the process and accountability for the team’s panel as a cornerstone of relationship-based care and population health management.^{[1], [2]}

Key change management and partnership steps may include:

• Provide targeted training so that role groups within the practice understand the purpose of empanelment and the implications of their role.
• Engage PCPs as workgroup leaders to help set parameters, make strategic decisions and guide the empanelment process.
• Develop and support standard work for teams to conduct panel management activities, including setting aside time for this critical population health function.

3. Develop consensus on policies, procedures and key empanelment parameters, and ensure clear and consistent communication and training on new expectations to staff.

General Empanelment Policies and Procedures

To ensure consensus, practices should develop an empanelment policy that is reviewed and approved yearly by executive leadership and the board.^[3] The policy should:

• Clearly define the purpose and process of empanelment.
• Describe key roles and responsibilities.
• Define procedures (both initial and ongoing empanelment) for establishing and assessing panel size, opening and closing panels, and other key empanelment steps.
• Codify the patient’s right to make both the initial PCP selection and PCP changes, as well as the frequency that PCP assignment is verified with the patient.
• List required reports, sample workflows and scripts for staff.

Defining Primary Care Provider Teams

Well-developed multidisciplinary primary care teams can serve as a multiplier of primary care supply, thereby increasing the ability of the practice to meet demand.^[4]

Although well organized teams with efficient workflows can increase supply, parttime clinical status of providers is a common challenge for practices and will create additional complexity for managing supply, demand and continuity. Some potential solutions include:

• Setting organizational policies that define a minimum full-time equivalency (FTE) for providers and/or set a minimum FTE threshold for maintaining a primary care panel.
• For providers with low clinical FTE, consider deploying those staff to episodic care environments (float, urgent care, PTO coverage, etc.).
• Forming PCP teams with two to three part-time PCPs to create a team with an overall status of 1.0 to 2.0 FTE altogether.
• Measuring continuity and other panel measures (e.g., care gap closures) for both the individual providers and the PCP teams.