2015 User Conference Understanding Your Patient Population April 25, 2015 (GEN-A60) Presented by: Susan J. Kressly, MD, FAAP Medical Director General Session

2015 Office Practicum User Conference Learning Objectives ▪ Understand why knowing key metrics of your patient population is important ▪ Identify 2 things you want to know about your patient population to improve practice financial health….and then go do it! ▪ Identify 2 things you want to know about your patient population to improve quality of care……and then go do it!

2015 Office Practicum User Conference Patients & the Business of Your Practice ▪ Who are your patients? ▪ Where do they come from? ▪ How do they utilize your office?

2015 Office Practicum User Conference Key Demographics to Practice Health ▪ Practice Panel ▪ Provider Panel per (PCP for primary care or responsible specialist) ▪ Age ▪ Insurance coverage ▪ Zip code

2015 Office Practicum User Conference Defining Active Patients ▪ CMS definition: has had at least one service provided by practice within the past 3 years ▪ How does your practice define “active?” ▪Patient register is “active” ▪Seen within the past 2 years ▪Record requests to transfer is easy (do you have a written policy on how to handle this?) ▪What about the “patients who are not engaged?” ▪ How do you manage the “not sure” group? ▪Periodic identification and outreach ▪Written policy to move to “inactive” status

2015 Office Practicum User Conference Identifying Active Patients Why does it matter? ▪ May have false sense of your total number of patients you are serving ▪ May be “leaking” patients to competition without being aware ▪ Insurance companies may be “attributing” these patients to your panel even though you don’t consider them active ▪Implications for HEDIS and P4P metrics ▪Implications for population payments moving forward ▪Ask payers to remove from your panel if efforts to engage them unsuccessful and you consider them “inactive”

2015 Office Practicum User Conference What Should the Panel Size Be? ▪ The number of patients you can effectively care for ▪ Varies based on multiple factors including style of provider, # of patients seen per day and # of hours worked per year ▪ AAFP has a worksheet based on the following formula: AAFP Panel size × visits per patient per year (demand) = provider visits per day × provider days per year (supply)

2015 Office Practicum User Conference Desired Patient Panel Size ▪ $$ matters also ▪Overhead ▪Provider financial expectations ▪Insurance contracts (including capitation and other payment models based on panel) ▪ Other reasons panel size might matter ▪Determining if/when to hire another provider ▪Determining whether to close/open a provider/insurance/practice panel

2015 Office Practicum User Conference Pediatric Practice Panel Size Trends ▪ Decreasing over the past few years ▪ Use to be 1,500-2,500 per FTE ▪ Many profitable practices now have 1,000- 1,250 ▪ Why? ▪Less “quick sick” (visits lost to RBCs, success of vaccines) ▪More well visits with better payment ▪More employed physicians? ▪More part time physicians? ▪More team based care?

2015 Office Practicum User Conference Why Define the Provider Panel? ▪ It makes patients happy ▪ It defines the workload ▪ It predicts patient demand ▪ It reveals provider performance issues ▪ It helps improve outcomes

2015 Office Practicum User Conference PCP Distribution Why such disparity? ▪ SJK cut back 1 day per week & closed panel ▪ SSM new to practice

2015 Office Practicum User Conference Ages of Patient Panel ▪ Is KEY to pediatric practices ▪ Regarding average number of visits, one infant is worth about 4 adolescents ▪ Ideal:

2015 Office Practicum User Conference What Happened? Practice had provider go out on maternity leave and closed to new patients

ACA??

2015 Office Practicum User Conference Insurance Distribution ▪ Depends on your geography ▪ Helps you strategize ▪Negotiating contracts ▪Dropping problematic/low payers ▪ The more diversity of good paying contracts, the stronger financial position

2015 Office Practicum User Conference Address / Zip Code How might we use this? ▪ May help shape marketing strategy ▪ Thinking of opening another office? ▪ Do NOT include PHI when exporting

Patient Demographics

2015 Office Practicum User Conference Other Interesting Demographic Info Birthday: why would a practice care?

2015 Office Practicum User Conference Birth Month Distribution Kressly Peds And the MOST popular birthday is……… JUNE 3 rd

2015 Office Practicum User Conference Moving toward Population Health ▪ Important to understand your patient needs ▪ Key to thriving in healthcare market moving forward ▪ Better positioned to negotiate fair payment ▪ Better positioned to plan effective practice business strategy

2015 Office Practicum User Conference Meaningful Use Demographics ▪ Race/Ethnicity ▪Can help you identify high risk patients ▪May help you decide to include culturally sensitive staffing ▪ Language ▪Can help you anticipate translation services needs ▪May help you decide on multi-lingual staffing ▪Will allow you to anticipate patient education/handout needs

2015 Office Practicum User Conference Clinical Demographics ▪ Problem List Frequency ▪Will allow you to create appropriate Care Plans ▪May inspire you to add additional services/personnel such as ▪Asthma educator ▪Diabetes educator ▪Purchase Spirometry ▪ Can assist with population risk stratification ▪Do your patients have more complex healthcare needs than your peers in your community? ▪Should you be paid more to coordinate their care?

2015 Office Practicum User Conference Utilization ▪ Do you know who your under-utilizers are? ▪Clinical care plan recalls should identify these patients ▪Both for well visits and chronic disease management care plans ▪How can you better engage them? ▪ Do you know who your over-utilizers are? ▪Visit history may not paint the whole picture ▪Staff often can identify “needy” patients ▪May need insurance cost data to identify “super- utilizers” ▪How can you better meet their needs?

2015 Office Practicum User Conference Is there one in your practice?

2015 Office Practicum User Conference Resources ▪ Free web chart tool Free web chart tool ▪ Directions on how to geomap addresses from a spreadsheetgeomap addresses ▪ Medscape article on estimating a reasonable patient panel size moving toward team-based care Medscape article ▪ AAFP article: Panel Size: How Many Patients Can One Doctor Manage?How Many Patients Can One Doctor Manage? ▪ AAFP article: It’s Time to Start Practicing Population- Based Health CareIt’s Time to Start Practicing Population- Based Health Care ▪ Medscape article: Primary Care Pediatrics and Public HealthPrimary Care Pediatrics and Public Health ▪ Super-utilizers: Common Themes from Innovative Complex Care Management ProgramsCommon Themes from Innovative Complex Care Management Programs

2015 Office Practicum User Conference Questions ?

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