What is the way to success in a high-intensity primary care program aimed at improving quality and lowering costs for a sub-set of patients with chronic conditions? It comes through increased patient and physician engagement, according to the results of a recent study by the Washington D.C.-based Center for Studying Health System Change (HSC) for the nonpartisan, nonprofit National Institute for Health Care Reform (NIHCR).

The study’s authors, a pair of researchers at HSC, came to this conclusion after looking at several of these types of programs throughout New Jersey, New York, Washington, Oregon, northern California, and multiple sites across the Southwest. Tracy Yee, Ph.D, one of the study’s authors and a HSC researcher, says programs focused on patients with diabetes, congestive heart failure, obesity, depression, and other chronic conditions require more help with care-coordination, beyond what’s available at traditional primary care practices.

These programs usually bring support to the patient in the form of a care coordinator, who helps guide them through the complex healthcare system. However, the success of these programs only comes through when both patients and physicians are fully engaged, the report’s authors say.

Trust Factor

The best way to get a patient engaged is through their physician, the report says.  According to Yee, the majority of patient respondents say they would enroll in certain elements of a high-intensity primary care program, including the program itself, if their physician personally invited them. Yee says this is because “first and foremost, patients trust their physicians.” If the patient got a call from their health plan, they’d be a little more leery, she says.

The care coordinators themselves, Yee says, need the physician to get their patients on board. “If you got a call from a care coordinator, it might be someone you’ve never heard of, and even if they’re good, they tend to be skeptical,” she says, noting that getting the physician to talk about it first, “Is not always possible.”

Another element of patient engagement, which is ultimately important to the effectiveness of the high-intensity primary care program, is rapid, direct access to providers. According to Yee, this idea of having a direct line of access to their patient is one of the strongest selling points for patients. The direct line of access could be a phone or secure email. Either way, it was embraced by patients, who noted their dislike for having to leave voice mails, or having to go through a phone tree.

Physician Recruitment Difficulties

For the success of these high-intensity programs, getting physicians on board is just as important as patients, the study mentions. However, that can be difficult due to time and resource factors. Yee says primary care physicians won’t accept anything that is perceived as additional work without having value added. She says they need to hear from fellow physicians that getting their patients enrolled in this type of program is worth the time and effort. It’s also a hard sell, she says, to get them to focus more intently on a specific number of patients, rather than their entire population. Recruitment of physicians, the study found, can take up to six months.

There are other challenges with getting physicians fully involved, including delegation. The report’s authors found physicians would have trouble delegating tasks to care coordinators. However, once they got over this, and created a rapport with the care coordinators, there was an obvious benefit to the program. Using algorithms successfully identified the right patients for the high-intensity program, Yee says, it gave them more incentive to get on board. When physicians had input themselves, it was another incentive for them. Once these challenges are overcome, the presence of an active, engaged physician in a high-intensity primary care program is invaluable, the report says.

Payers are Important

Another element to success in these programs is the payers, the research’s authors say, noting that they have interest in better, lower-cost care just like the providers and patients. According to Yee, payers have claims data, which providers won’t have access to and can be leveraged to track outcomes. In fact, she says, this is the first thing she would do if she was a CIO interested in starting up a high-intensity primary care program for patients with chronic diseases.

Once the payer is on board, the provider needs to work on getting physicians involved. Then it’s finding the right patients for the program. The study’s entire findings can be found in an NIHC Research Brief, High-Intensity Primary Care: Lessons for Physician and Patient Engagement.