Staffing Right for Population Health in Small Practices

A successful population health strategy emphasizes a patient-centered model focused on quality care. However, it is virtually impossible to offer each and every thing to each and every individual. For small practices, in particular, this reality requires evaluating staffing needs and prioritizing areas to optimize support staff optimally to the benefit of patients.

"When a population strategy is instituted in a practice, scheduling and workflow changes are required," says Yomi Ajao, vice president of COPE Health Solutions. This may mean, for example, setting aside certain hours to see high-risk patients to ensure appropriate care coverage is available and minimize disruptions for other patients.

In making any changes to staffing within a practice, always keep the patient-physician relationship in mind, experts say. Before adding or reducing staff, or shifting responsibility around a medical team, ask how these changes support that relationship. As in most industries, customer service is essential to creating trust and rapport, which helps strengthen and empower patient care in population health.

Practices hoping to maximize fee-for-service revenue by meeting value-based performance thresholds may be able to meet their goals using existing or minimal new staff. In order to add more preventative care services, increase wellness exams and close care gaps, practices can strategically expand care teams with nurse practitioners qualified to conduct exams and screenings, and provide immunizations and transition-of-care support. "The new positions tend to be cost-neutral or even net-positive due to the revenue generating services they provide, decreasing the reliance on a larger health system for funding," says Lillian Lee-Chun, a manager at ECG Management Consultants.

However, small practices hoping to provide comprehensive population management across the entire care spectrum may find themselves overwhelmed. "Given the growing complexity of the patient population, patients are increasingly seeing specialists and require care in acute settings," Lee Chun says. Bearing the responsibility for the total cost of care for a patient requires a system-wide perspective and connected information system, and it puts physicians at risk when other providers in the system may not be aligned or incentivized by the same outcomes as the practice, she adds. As such, any comprehensive care will most likely require integration with the larger medical system in which patients interact.

In addition to hands-on care, small practices may benefit from collaborating in other areas. For example, leveraging technology-related resources for data connectivity and data analytics from an affiliated management service organization (MSO) or clinical integrated network (CIN) would be effective, experts say.

Staffing changes focused on population health will not happen overnight. As such, small practices need to recognize and take advantage of resources available through affiliated population health partners or larger systems.

Experts say practices need to reevaluate staffing needs, and look for opportunities to offload appropriate activities from higher licensed staff to lower licensed staff. "If coupled with patient identification protocols, safe and high-quality care can be maintained," Ajao says. Finally, make small adjustments to the practice's scheduling process to minimize disruption, always keeping the patients' needs at the forefront.