News & Commentary

PCP Involvement Boosts Prevention

Prevention works if orchestrated by primary care physicians (PCPs) who can perform 60- to 90-minute annual physicals, as opposed to the 15-minute examination that’s the norm, says a study in Population Health Management. Researchers with Optum, United­Healthcare’s data management and IT arm, argued that the “personalized preventive health care” that fosters a close doctor–patient relationship cuts hospital and urgent care facility costs and manages chronic diseases better.

Who pays? In this instance, the patient. The study compared about 10,000 UnitedHealthcare enrollees in a network called MD-Value in Prevention (MDVIP) with about 10,000 United non-MDVIP members. The MDVIP members paid a fee of about $150 a month, similar to the fee that concierge medical practices charge.

Did the program work? Yes, with some caveats. Average medical and pharmacy costs for years 1, 2, and 3 exceeded those of non-MDVIP patients, thanks to increased pharmaceutical costs and more stringent management of chronic disease. On the other hand, there were significantly lower rates of ED visits and urgent care facility use by MDVIP members. (Data were collected from 2009 to 2014.)

The idea was to at least cover the $150 fee. “In years 1 and 2, 24% to 26% achieved savings at this level,” the study states. “By year 3, 63% (most between $150 and $299 per month savings) had achieved positive savings at or above their monthly membership fees, making a shift over time to increased proportions of the population achieving savings.”

The annual 60- to 90-minute examination included health screenings (for depression, anxiety, sleep problems, nutrition, sexual function, vision, hearing), diagnostic testing (for diabetes, bone disease, cardiovascular disease), and wellness consultations, which included personalized coaching and online instruction for exercise and weight control.

The wellness piece is crucial. Lifestyle counseling is not offered consistently by PCPs, the study notes.

“Obstacles to effective lifestyle counseling by PCPs have been identified, including lack of time, re­imbursement, and training, as well as physician skepticism regarding patient adherence,” the study states.

Savings from care for older patients were achieved earlier as chronic conditions came under control; it was achieved later for younger patients as prevention took root, according to the study. The study included people aged 35 to 84.

The MDVIP approach seems counter­intuitive, in a sense, when health care braces for a doctor shortage. MDVIP physicians see about 600 patients a year, as opposed to the usual volume for a PCP of about 2,000 patients annually. MDVIP includes about 700 PCPs caring for about 250,000 patients nationally.

Andrea Klemes, DO, the study’s corresponding author, tells Managed Care that the model motivates physicians to keep working. “Many tell us that if not for MDVIP, they would have left practice altogether. The model also inspires medical students to consider primary care as a career path when, for the past decade, fewer have opted to go into this field.”

The patient fees pay only for the extended wellness and prevention visits. Other services, such as specialist visits, lab work, and imaging, are covered by traditional health insurance.

Employer health management programs usually aren’t administered by PCPs, even though PCPs can better manage those with complex medical conditions, the authors advise.

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