One of the most powerful change ideas to reduce demand is to promote continuity with the primary care provider (PCP) and the care team at all times. When a patient is deflected to Urgent Care, or even to another provider on the team, they may often be instructed to check back with their PCP, or choose to do so on their own, thus creating a second demand on the system. The PCP is in the best position to "max-pack" at that visit, possibly reducing future demand even more.

Practices can promote continuity by first committing to it. Once providers, nurses, and appointment staff all view continuity with the PCP as a priority, then scheduling and nursing staff can script the appointment interaction. The only situations in which a patient should be deflected to an alternate provider or to Urgent Care is if the PCP is absent, or if the patient prefers this option because he or she cannot wait. Sometimes it is helpful for a mid-level provider to carry a smaller panel of patients and be the first provider assigned to see a patient for a provider who is absent. 

A good example of how practices have improved continuity is to route all patient-related work to the PCP/care team. To do this, consider all members of the care team when planning a patient visit (e.g., nurses can be responsible for flu shots or physician assistants for some post-procedure follow-up). This helps to reduce demand for appointments with the physician. Be careful to schedule the patient for the appropriate level of care the first time. For example, if a patient's needs require him or her to see the physician, schedule the appointment with the physician instead of the physician assistant (PA) to avoid creating demand for two appointments. Conversely, if the level of care indicated dictates that a nurse or PA can meet the patient's needs, it is not necessary to schedule an appointment with the physician.

Once clinical teams have fixed panels of patients, the practice should devise a streamlined process for connecting incoming work with that team. Practices using paper charts might label their charts with colored tape as a signal to reduce time spent finding the answer to the question, "Who gets this work?"

Related Measure

Patient Continuity