The Whole Patient and Nothing but the Patient

June 26, 2018

Chronic care management is available under Medicare but has been underused thus far.

We’ve all heard the saying, “Treat the patient, not just the disease.” However, new research shows that ever increasing time constraints on physicians make that easier said than done.

According to a recent survey by Quest Diagnostics, 95% of primary care physicians (PCPs) say they became a doctor to treat the “whole patient.” Yet, two-thirds of PCPs (66%) say they don’t have time and/or bandwidth to worry about non-physical, social issues of their older patients with multiple conditions.

The report provides insight into gaps in care affecting the nearly 3 in 4 Americans over the age of 65 with 2 or more chronic health conditions. It is based on responses to a survey by patients in this population and primary care physicians who care for them.

Medicare patients with multiple chronic conditions are generally sicker, more likely to use hospitals and emergency departments, have greater limitations in their daily living, and experience accelerated decline in their quality of life. Care for chronic conditions such as hypertension, cancer, diabetes and arthritis accounts for an estimated 71% of all healthcare costs.1

Key findings from the Quest survey put the challenge of delivering care to these patients in stark relief:

  • Almost 9 in 10 PCPs (86%) say they have felt unable to address the needs of their chronic care patients adequately—with 3 in 10 (28%) saying this happens frequently.
  • For most physicians—85%—lack of time was cited as the key culprit.
  • 89% of PCPs say their office tries to follow up with our patients with multiple chronic conditions, “but there is only so much we can do.”

Patients, meanwhile, may not equate behavioral and social issues to the care they receive from their primary doctor. Two in 5 patients (44%) surveyed by Quest say that while they tell their doctor about their medical conditions, they do not tell them about non-medical issues they’re facing such as loneliness, financial, and transportation issues. Many of them are afraid of falling in or outside the home and of developing other conditions, but they do not share these concerns with others for fear of being a “burden.” About one-third (32%) say sometimes they feel like no one understands all the things they’re going through.

It would seem that the aim of managed care to treat patients holistically, lower costs, and improve care is falling short.

Yet, the results of the survey are not all doom and gloom. In fact, it provides insights into options PCPs can consider to aid their goal to treat the whole patient.

One of these options is Chronic Care Management. In 2015, the CMS began to reimburse for CCM to supplement the annual wellness visit. Beneficiaries with 2 or more chronic health conditions may receive care from qualified healthcare professionals via phone or other non-face to face meetings. CMS reimburses an average of $42 per patient for 20 minutes of non face-to-face care.

Participation in CCM programs by PCPs has been slow (although CMS estimates 70% of Medicare beneficiaries—roughly 35 million people—would be eligible). In this regard, the Quest survey has some insights into why.

According to the survey, most PCPs (87%) see value in CCM services to help monitor their CCM patients. Yet, only half (51%) surveyed know that CMS may reimburse for CCM for Medicare beneficiaries with multiple chronic conditions. And fewer than 1 in 4 (23%) have implemented CCM, citing complexity of coding (43%) and burdensome paperwork (37%) as key barriers. The full report can be found here.

So, are there measures PCPs can take when implementing CCM to make the process worthwhile? Our experience suggests there are several that may provide the greatest benefits.

Start Small. Before launching a major transformation of your practice, pilot CCM with a subset of patients. Then, take the lessons you learn from this segment of patients to inform strategies for a larger population.

Address Preconceived Notions. The Quest survey suggests that most patients would be open to CCM, but they may have preconceived notions that could limit adoption. For instance, while nearly half of patients (45%) surveyed say they would be likely to access CCM services, that number jumps to 58% when patients are informed that it is a covered benefit through Medicare.

Position CCM as a Tool of Independence. The number one cited fear of patients in the Quest survey was developing another medical issue. The next cited worry was being a burden on caregivers. Explain to patients that CCM can help identify and preempt potential health concerns before they become a major issue, so they can retain their health and independence longer.

Seek Outside Help. Despite efforts by CMS to simplify coding, adopting CCM can still be a daunting task for some practices. CCM specialists who understand healthcare services and know how to be a trusted extension to a physician’s practice may be an appropriate option for some.

PCPs want to care for the whole patient. Patients deserve that level of concern. CCM can help extend the busy physician’s ability to care for individuals with chronic health conditions. With improved monitoring, these patients may expect to achieve a better quality of life.

Reference

  1. American Association of Retired Persons. Chronic conditions among older Americans: a call to action for health reform. AARP website. assets.aarp.org/rgcenter/health/beyond_50_hcr_conditions.pdf. Published March 2009. Accessed June 22, 2018.