Data doesn't add hours. It aims them.
I built a simulation of one year in a 2,500-patient panel and ran it four ways. The result I didn't expect: aiming the hours mattered more than adding them.
In a toy model of a full panel, connecting the data (worklists, ED alerts) cut avoidable ED visits by almost half without adding an hour. Nearly tripling the hours with a team, but leaving the red tape on, cut them by about a third. Doing both cut them by almost 90%. Hours decide how much care you can give. Data decides who gets it.
One year, 2,500 patients, two worlds side by side. Flip the switches and watch where the ED visits land.
I wanted to see two things at once: what a team changes, and what clean data changes. You can't run that experiment on real patients. So I built a small one.
The setup
Picture 2,500 dots. Each one is a patient. Most are low risk, some are rising, a few are high risk.
Every day, a little care wears off. Screenings come due. Numbers creep. Refills lapse. High-risk patients slip fastest.
Every day, the practice pushes back. How much it can push depends on its hours. I used the real budget from the study behind the 27-hour day: a doctor alone can deliver about 30% of the recommended care for 2,500 adults. With a team, about 86%.
Then one more switch: red tape.
- Red tape on. Care goes to whoever books. When a patient lands in an outside ED, the practice hears about it about a third of the time.
- Red tape off. A worklist sends care to whoever is slipping or overdue. Every ED visit triggers a follow-up.
The patients, drift rates, and ED risk are invented. The hours are real. It is a toy, and I treat it like one.
Four runs, same patients
Same 2,500 patients. Same starting point. One year each. The default run:
| World | Avoidable ED visits | Nobody followed up | Uncontrolled at year end |
|---|---|---|---|
| Alone, red tape on | 352 | 248 | 27% |
| Alone, data flowing | 194 | 0 | 24% |
| Team, red tape on | 227 | 170 | 10% |
| Team, data flowing | 41 | 0 | 4% |
What surprised me
Connecting the data, with no new hours at all, cut ED visits by about 45%. Nearly tripling the hours with a team, while leaving the red tape on, cut them by about 35%.
Aim beat effort.
It makes sense once you watch it. With red tape on, the extra hours mostly go to whoever calls first. The quiet, high-risk patient who is slipping doesn't call. With data flowing, the worklist finds them before the ED does.
The trade nobody mentions
Aiming isn't free. In the aimed worlds, a few more of the patients who were doing fine end the year a little overdue. The hours went to someone sicker. That's the right trade, but it is a trade, and a practice should make it on purpose.
What I take from it
- Hours set the ceiling. Alone, no amount of clever aiming gets a full panel under control. The math from the 27-hour day still holds.
- Data sets the aim. The same hours do far more when they go to the right people.
- Follow-up is the cheapest win. Simply hearing about an ED visit, and calling, removed hundreds of dead ends.
The fix isn't a faster doctor. It's a doctor who knows where to look.
Run it yourself. Flip the switches mid-year and watch the dots change color: Panel Weather.
Check yourself
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