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The Impact of Flexibility And Capacity Allocation On The Performance of Primary Care Practices

The two important metrics for any primary care practice are: (1) Timely Access and (2) Patient-physician Continuity. Timely access focuses on the ability of a patient to get access to a physician as soon as possible. Patient-physician continuity refers to building a strong or permanent relationship between a patient and a specific physician by maximizing patient visits to that physician. In the past decade, a new paradigm called advanced access or open access has been adopted by practices nationwide to encourage physician to “do today’s work today.” However, most clinics still reserve pre-scheduled appointments for long lead-time appointments due to patient preference and clinical necessities. Therefore, an important problem for clinics is how to optimally manage and allocate limited physician capacities as much as possible to meet the two types of demand – pre-scheduled (non-urgent) and open access (urgent) – while simultaneously maximizing timely access and patient-physician continuity. In this study we use a quantitative approach to apply the ideas of manufacturing process flexibility to capacity management in a primary care practice. We develop a closed form expression for capacity allocation for an individual physician and a two physician practice. In the case of multiple physicians, we use a two-stage stochastic integer programming approach to investigate the value of flexibility under different levels of flexibility and provide the optimal capacity allocation solution for each physician. We find that flexibility has the greatest benefit when system utilization is balanced and when the individual physicians have unequal utilizations. The benefits of flexibility also increase as the practice gets larger.