Dollars and Sense

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As we enter the new year of 2019, you may get a call out of the blue from your doctor’s office, a care management program like an ACO, or possibly your health insurance company.  One likely reason would be to schedule your annual wellness exam.  Other reasons could be to schedule an age based recommended mammogram, colonoscopy or Pap smear.  Perhaps it is to remind you of procedures like an eye exam for diabetics or labs that are scheduled or otherwise due.  For those patients with chronic diseases, it is critical to receive preventive and proactive care, as most problems will otherwise just get worse – and more expensive to treat.

The concept is called Population Health Management, and comes as both public and private payers focus on “value-based care”.  If we are able to be preemptive in providing timely care, we may be able to prevent or better control common diseases.  Primary care has been tasked by insurance companies with the challenge of tracking and coordination of a person’s care.  Communication between primary, specialty and hospital care may prevent duplication of services or tests, thus keeps cost down.  Awareness and reconciliation of medications provided to patients among these entities may also minimize the risk of dangerous drug interactions. 

The challenge of primary care providing population health can be difficult but not impossible.  It is necessary to identify those chronic disease patients who may benefit from outreach programs.  To do so requires electronic health records to compile and organize this data.  As a rule, a health care team manages the scheduling, tests and outcome records to assure that no patient is overlooked.  Such a program provides an opportunity for improvement, and truly does help patient care.

My first visualization of population health was that of my patients becoming rows and columns on a spreadsheet.  I would no longer be caring for my patients, but be asked to treat all of the “red” cells on the form.  But now, seeing the benefits of this organized data, we can easily find a patient who is due for timely lab or coming due for a visit and contact them accordingly.  It also allows reporting, for example, that our diabetics are achieving their treatment goals, or that routine preventive care has been provided.     

Care Management Services (CMS) is already providing financial payments or penalties to physicians for their Medicare patients who are meeting the guidelines or not.  Private payers may determine their continued contracting with your doctor depending on practices meeting the performance measures designed by the carrier.  As these programs expand and develop, we should have better data and better processes to gain markedly improved outcomes.

Health care costs continue to rise despite the Affordable Care Act.  We still have an uninsured and underinsured population.  The United States continues to spend the most money per capita of any country in the world, costing almost half again the Scandinavian countries who provide universal care to their entire populace.  If we are to curb our exploding cost of care, we need to embrace better accountability of health care and outcomes.  When asked to schedule your annual wellness exam, get medical testing, or follow up for your chronic health care, I encourage your compliance.  Ask your provider if they are participating in Population Management, as this may be the best means yet to improve health care, compliance, costs and outcomes.


Bradford Croft, DO

East Flagstaff Family Medicine