How a new practice ramps
A new practice does not enrol everyone at once. The share of eligible patients who are active climbs for several months and then levels off. This build uses invented start groups. Move the forecast ramp and see where it sits against what earlier groups did, and what the gap is worth in revenue.
What this shows
- A curve for each start quarter, with the forecast ramp drawn over them
- A fit check by month showing where the forecast runs high or low
- A triangle of go-live months against calendar months
- A slider for a slower or faster ramp and the revenue it moves
How I use it
- Setting a ramp from what earlier groups actually did
- Spotting a group that is far off the curve early
- Showing leadership how much a slower start costs
Explore the model below. It uses an invented company and invented numbers.
Explore the model
Illustrative model · Synthetic dataWide tables scroll sideways: swipe inside a table to see every column.
Sample build: how a new practice ramps
An invented remote care service brings a medical practice live. Only some of the practice's eligible patients are active at first, and the share climbs month by month. This build sets a forecast ramp against five invented start groups, shows where the forecast runs high or low, and prices a slower or faster start.
Invented service, practices and numbers for illustration. Revenue per patient is an illustrative rate.
What to try
- Drag Ramp pace down to 70 percent and read how much first-year revenue it takes out. A slower start costs the most in the early months.
- Open the Fit check tab. The forecast runs high in months 2 to 4 because the newest group started slowly. Press Group average to close most of that gap.
- Open the Triangle tab and switch to measured cells. Each row is one start group, and the ramp slides to the right with each later go-live month.
- Raise churn, then open the One practice tab. It shows how many new patients it takes just to hold the ramp.
The ramp entered for this practice, 5 percent active in month 1 rising to 55 percent.
Edit the forecast ramp month by month
Share of eligible patients who are active, in whole percent. Month 1 is the month the practice goes live. The run-rate applies from month 13 onward.
Active at month 6
216
of 600 eligible patients
Active at month 12
324
54.0% of eligible patients
Months to 90% of run-rate
10
Run-rate is 330 active patients
Revenue, first 12 months
$175,560
One practice
Moved by ramp pace, first 12 months
$0
Compared with 100% pace
Five start groups, 24 months
$3,769,920
$0 compared with 100% pace
Share of eligible patients active, by months since go-live
Each coloured line is one start group, drawn only for the months it has been live. The white line is the forecast ramp at the pace set above. The newest group has four months of history and is the slowest of the five.
Horizontal axis: months since go-live. Month 1 is the month the practice goes live.
The numbers behind the chart
| Month | Forecast | Y1 Q1 | Y1 Q2 | Y1 Q3 | Y1 Q4 | Y2 Q1 |
|---|---|---|---|---|---|---|
| 1 | 5.0% | 4% | 6% | 5% | 7% | 3% |
| 2 | 11.0% | 10% | 12% | 11% | 13% | 7% |
| 3 | 18.0% | 18% | 17% | 17% | 21% | 10% |
| 4 | 25.0% | 23% | 27% | 24% | 27% | 14% |
| 5 | 31.0% | 31% | 32% | 30% | 34% | - |
| 6 | 36.0% | 35% | 39% | 34% | 38% | - |
| 7 | 41.0% | 43% | 41% | 41% | 45% | - |
| 8 | 45.0% | 46% | 47% | 44% | - | - |
| 9 | 48.0% | 49% | 50% | 48% | - | - |
| 10 | 51.0% | 53% | 50% | 52% | - | - |
| 11 | 53.0% | 54% | 53% | - | - | - |
| 12 | 54.0% | 56% | 55% | - | - | - |
| 13 | 55.0% | - | - | - | - | - |
| 14 | 55.0% | - | - | - | - | - |
| 15 | 55.0% | - | - | - | - | - |
| 16 | 55.0% | - | - | - | - | - |
| 17 | 55.0% | - | - | - | - | - |
| 18 | 55.0% | - | - | - | - | - |
A hyphen means the group has not been live that long yet.
Average miss
0.9 points
Average size of the monthly gaps, ignoring direction
Net gap
-0.3 points
The forecast runs low on balance
Largest miss
+2.0 points
In month 4
Months high and low
3 high, 8 low
Forecast above or below the group average
Where the forecast runs high or low
The gap is the forecast share minus the average of the start groups that have been live that long. A plus means the forecast expects more active patients than the groups delivered. Later months rest on fewer groups, so read them with care.
Bars show the gap in points. Horizontal axis: months since go-live.
| Month | Groups seen | Group average | Forecast | Gap (points) |
|---|---|---|---|---|
| 1 | 5 | 5.0% | 5.0% | 0.0 |
| 2 | 5 | 10.6% | 11.0% | +0.4 |
| 3 | 5 | 16.6% | 18.0% | +1.4 |
| 4 | 5 | 23.0% | 25.0% | +2.0 |
| 5 | 4 | 31.8% | 31.0% | -0.8 |
| 6 | 4 | 36.5% | 36.0% | -0.5 |
| 7 | 4 | 42.5% | 41.0% | -1.5 |
| 8 | 3 | 45.7% | 45.0% | -0.7 |
| 9 | 3 | 49.0% | 48.0% | -1.0 |
| 10 | 3 | 51.7% | 51.0% | -0.7 |
| 11 | 2 | 53.5% | 53.0% | -0.5 |
| 12 | 2 | 55.5% | 54.0% | -1.5 |
Is any one group far off the curve?
| Start group | Practices | Months seen | Gap (points) | Status |
|---|---|---|---|---|
| Y1 Q1 | 2 | 12 | +0.3 | On the curve |
| Y1 Q2 | 3 | 12 | +0.9 | On the curve |
| Y1 Q3 | 2 | 10 | -0.5 | On the curve |
| Y1 Q4 | 3 | 7 | +2.6 | A little off |
| Y2 Q1 | 2 | 4 | -6.2 | Far off the curve |
The gap is the group's share minus the forecast share, averaged over the months the group has been live. A group is on the curve when the size of that gap is under 2 points, a little off from 2 to under 4, and far off at 4 or more.
What to do with a group far off the curve
- Do not change the forecast because of one group. Early months are noisy, and a slow start can still catch up.
- Find the cause first: a late device delivery, a change of staff at the practice, or a smaller share of patients reached.
- Decide whether it is a delay or a lower level. A delayed group follows the same shape later. A lower level stays under the curve.
- Keep the group in the average but mark it, and check it again each month. Move the forecast when two or more groups show the same pattern.
Each row is a start group. Each column is a calendar month, and month 1 is the month the first group went live. Read along a row to follow one group up its ramp. Read down a column for all active patients in one month. Cells before a group goes live are dark and empty.
Forecast: every live cell is the group's eligible patients times the forecast ramp at the pace set above.
Patient-months in 24 months
53,856
Active patients added up over every calendar month
Revenue in 24 months
$3,769,920
Patient-months times revenue per active patient
Active patients by go-live group and calendar month
| Start group | Live in | Eligible | M1 | M2 | M3 | M4 | M5 | M6 | M7 | M8 | M9 | M10 | M11 | M12 | M13 | M14 | M15 | M16 | M17 | M18 | M19 | M20 | M21 | M22 | M23 | M24 | Total |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Y1 Q1 2 practices | M1 | 1,200 | 60 | 132 | 216 | 300 | 372 | 432 | 492 | 540 | 576 | 612 | 636 | 648 | 660 | 660 | 660 | 660 | 660 | 660 | 660 | 660 | 660 | 660 | 660 | 660 | 12,936 |
| Y1 Q2 3 practices | M4 | 1,800 | 90 | 198 | 324 | 450 | 558 | 648 | 738 | 810 | 864 | 918 | 954 | 972 | 990 | 990 | 990 | 990 | 990 | 990 | 990 | 990 | 990 | 16,434 | |||
| Y1 Q3 2 practices | M7 | 1,200 | 60 | 132 | 216 | 300 | 372 | 432 | 492 | 540 | 576 | 612 | 636 | 648 | 660 | 660 | 660 | 660 | 660 | 660 | 8,976 | ||||||
| Y1 Q4 3 practices | M10 | 1,800 | 90 | 198 | 324 | 450 | 558 | 648 | 738 | 810 | 864 | 918 | 954 | 972 | 990 | 990 | 990 | 10,494 | |||||||||
| Y2 Q1 2 practices | M13 | 1,200 | 60 | 132 | 216 | 300 | 372 | 432 | 492 | 540 | 576 | 612 | 636 | 648 | 5,016 | ||||||||||||
| All groups | 7,200 | 60 | 132 | 216 | 390 | 570 | 756 | 1,002 | 1,230 | 1,440 | 1,740 | 2,016 | 2,268 | 2,580 | 2,844 | 3,072 | 3,300 | 3,468 | 3,594 | 3,720 | 3,804 | 3,858 | 3,912 | 3,936 | 3,948 | 53,856 |
- Forecast
- Measured
- Not live yet
- Go-live month
One practice goes live in month 1 with 600 eligible patients. The ramp says how many should be active each month. Patients lost in a month are the opening balance times the churn rate, rounded. New patients are whatever it takes to land on the ramp. Once the ramp levels off, new patients only replace the ones lost.
Active at month 12
324
54.0% of eligible patients
New patients, first 12 months
380
Enrolled to follow the ramp
Lost to churn, first 12 months
56
Patients who stopped during the year
Revenue, first 12 months
$175,560
Active patients times revenue per patient
Month by month for one practice
| Month | Share active | Opening | New | Churned | Closing | Revenue |
|---|---|---|---|---|---|---|
| 1 | 5.0% | 0 | 30 | 0 | 30 | $2,100 |
| 2 | 11.0% | 30 | 37 | 1 | 66 | $4,620 |
| 3 | 18.0% | 66 | 44 | 2 | 108 | $7,560 |
| 4 | 25.0% | 108 | 45 | 3 | 150 | $10,500 |
| 5 | 31.0% | 150 | 40 | 4 | 186 | $13,020 |
| 6 | 36.0% | 186 | 35 | 5 | 216 | $15,120 |
| 7 | 41.0% | 216 | 35 | 5 | 246 | $17,220 |
| 8 | 45.0% | 246 | 30 | 6 | 270 | $18,900 |
| 9 | 48.0% | 270 | 25 | 7 | 288 | $20,160 |
| 10 | 51.0% | 288 | 25 | 7 | 306 | $21,420 |
| 11 | 53.0% | 306 | 20 | 8 | 318 | $22,260 |
| 12 | 54.0% | 318 | 14 | 8 | 324 | $22,680 |
| 13 | 55.0% | 324 | 14 | 8 | 330 | $23,100 |
| 14 | 55.0% | 330 | 8 | 8 | 330 | $23,100 |
| 15 | 55.0% | 330 | 8 | 8 | 330 | $23,100 |
| 16 | 55.0% | 330 | 8 | 8 | 330 | $23,100 |
| 17 | 55.0% | 330 | 8 | 8 | 330 | $23,100 |
| 18 | 55.0% | 330 | 8 | 8 | 330 | $23,100 |
| 19 | 55.0% | 330 | 8 | 8 | 330 | $23,100 |
| 20 | 55.0% | 330 | 8 | 8 | 330 | $23,100 |
| 21 | 55.0% | 330 | 8 | 8 | 330 | $23,100 |
| 22 | 55.0% | 330 | 8 | 8 | 330 | $23,100 |
| 23 | 55.0% | 330 | 8 | 8 | 330 | $23,100 |
| 24 | 55.0% | 330 | 8 | 8 | 330 | $23,100 |
Pace stretches or squeezes the time the ramp takes. At 80 percent each level is reached 1.25 times as late, and at 120 percent it is reached sooner. The run-rate does not change, so the revenue that moves is in the months before the ramp catches up. Use the pace slider above to set your own row.
Revenue moved in the first 12 months, one practice
Bars compare each pace with 100 percent, the forecast as entered. Horizontal axis: pace as a share of the forecast.
The numbers behind the chart
| Pace | Active at month 12 | Revenue, first 12 months | Moved, one practice | Five groups, 24 months | Moved, five groups |
|---|---|---|---|---|---|
| Your setting, 100% | 324 | $175,560 | $0 | $3,769,920 | $0 |
| 60% | 251 | $117,110 | -$58,450 | $2,917,460 | -$852,460 |
| 80% | 299 | $149,800 | -$25,760 | $3,434,830 | -$335,090 |
| 100% | 324 | $175,560 | $0 | $3,769,920 | $0 |
| 120% | 330 | $194,250 | +$18,690 | $3,993,710 | +$223,790 |
| 140% | 330 | $207,690 | +$32,130 | $4,155,900 | +$385,980 |
The five-group columns use the 24-month calendar from the Triangle tab. Moved means the change against the forecast pace of 100 percent.
10 of 10 checks pass on the current inputs. Each one tests that the parts add up to the totals for whatever the sliders are set to, and a fail would name the first thing that broke.
| Check | Result |
|---|---|
| Active patients equal eligible patients times the ramp, rounded, in every month | Pass |
| Each month opens with the last closing balance, and opening plus new minus churned gives closing | Pass |
| Closing patients match the active patients the ramp calls for | Pass |
| Revenue equals active patients times revenue per patient, added up | Pass |
| Triangle totals agree across rows, calendar months and the grand total, in both views | Pass |
| Triangle cells use the single practice ramp, or the measured share where there is one | Pass |
| No patients are counted before a group goes live | Pass |
| Each gap is the forecast minus the group average, and the average miss ties to the gaps | Pass |
| A pace of 100 percent moves revenue by nothing | Pass |
| Every number is a real number | Pass |
At 100% of the forecast pace, a practice with 600 eligible patients has 324 active at month 12 and earns $175,560 in its first 12 months, the same as at 100 percent pace. On average the forecast sits 0.9 points away from the group average each month.