“Managing Office Revisit Intervals and Patient Panel Sizes in Primary Care” by Dr. Sergei SAVIN
Dr. Sergei SAVIN, Associate Professor of Operations, Information and Decisions, The Wharton School, University of Pennsylvania
Professor Savin’s research expertise is centered on operational aspects of health care delivery, improving patient access to care, and optimal management of diagnostic and treatment capacity. His articles have appeared in Management Science, Operations Research, and Manufacturing and Service Operations Management, among others, and he also actively participates in editorial activities for several premier journals including Management Science, Operations Research, Manufacturing and Service Operations Management, and Production and Operations Management. Professor Savin teaches a PhD course on optimization, the core MBA course on Business Analytics, and the core undergraduate course on Operations and Information Management. Before joining the Wharton School in July 2009, Professor Savin was on the faculty at the Columbia Business School and the London Business School. He received a Ph.D. in Physics from the University of Pennsylvania in 1997 and a Ph.D. in Operations and Information Management from the Wharton School in 2001.
In recent years, the drive to contain health care costs in the US has increased scrutiny of the traditional mode of delivering primary care where a patient is treated by his primary care physician during a face-to-face visit. In particular, two approaches, the use of "e-visits" and greater reliance on non-physician providers, have been suggested as lower-cost alternatives to the traditional set-up. In this paper, we consider a homogeneous patient panel treated by a solo primary care physician and develop a new model of patient health dynamics in which the health state for each patient on the physician's panel follows Markovian transitions between "healthy", "intermediate" and "sick" states. In contrast to most currently used models, we treat patient demand for office visits as endogenous and managed by a physician via selection of a revisit frequency consistent with patient preferences. We model these preferences for the frequency of office visits using patients' perception of their health status as well as the disutility associated with falling sick. At the center of our analysis are the interconnected decisions that a physician makes regarding the size of her patient panel and the patient revisit frequency under alternative primary care delivery modes. Our results quantify the overall impact of using "e-visits" and non-physician providers on physician's choices, and, as a result, on physician's expected earnings and patients' expected health. In particular, we characterize care settings, defined in terms of care effectiveness, characteristics of patient panel, as well as physician's compensation scheme, that result in both parties, physician and patients, being better off (i.e., increased expected earnings for a physician and better health for patients) as well as settings where at least one of the parties is worse off as compared to the traditional approach to care delivery.
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