Redesigning Primary Care Delivery: Customized Office Revisit Intervals and E-Visits

Abstract

The demand for physician services in primary care is shaped by the number of patients associated with each physician and the frequency of scheduled office visits. While a physician can typically set the size of her patient panel without regard for individual patient preferences, office revisit intervals are determined jointly by the physician and her patients. We analyze these decisions by modeling patient demand for office visits as a function of office revisit intervals. In our model, a physician can manage the demand for her services using two "customization" approaches. On one hand, she can adjust the office revisit intervals based on patient health status. On the other hand, she can divert some of the patient demand away from the office visits and into the "e-visits", which utilize less of the physician's service capacity while still maintaining an appropriate quality of care. Using our model, we characterize care settings, defined in terms of patient panel features, parameters of primary care delivery, and physician compensation schemes, that result in increased expected earnings for the physician, larger panel size, and improved patient health. We also describe settings in which customization of care may lead to worse outcomes on at least one of these dimensions.

Keywords: panel size, health care operations, primary care, patient revisit intervals