High-Intensity Primary Care: Lessons for Physicians and Patient Engagement

Physicians Value Say in Which Patients Participate; Patients Value Rapid Access to Physicians

News Release
Oct. 4, 2012

Alwyn Cassil (202) 264-3484 or acassil@hschange.org

WASHINGTON, DC—If fledgling efforts to improve quality and lower costs by focusing extra primary care attention on patients with complex conditions are to succeed, ensuring physicians and patients are on board will be key, accordingto a new qualitative study by the Center for Studying Health System Change (HSC) for the nonpartisan, nonprofit National Institute for Health Care Reform (NIHCR).

So-called high-intensity primary care programs typically focus on a subset of patients with complex or multiple chronic conditions, such as diabetes, congestive heart failure, obesity and depression, providing them with additional care coordination, management and health education far beyond what is offered in traditional primary care practices. The high-intensity primary care model typically involves primary care physicians (PCPs) supported by care coordinators who help complex patients navigate the health system, adhere to treatment plans and improve self-care of their conditions.

A number of factors can foster physician and patient engagement in high-intensity primary care programs, the study found. For physicians, key factors include a say in which patients participate; financial commitment and administrative support from health plans; and well-designed financial incentives for quality and outcome improvements.

To encourage patient engagement, a personal invitation from physicians to join a high-intensity primary care program, as well as rapid access to physicians and care coordinators, appear to be highly successful approaches, according to the study.

“Early assessments of high-intensity primary care programs show promise, but engaging physicians and patients will be key to whether these programs succeed more broadly in improving quality and lowering costs,” said Tracy Yee, Ph.D., HSC researcher and coauthor of the study with Amanda Lechner, M.P.P., HSC health policy analyst; and HSC Senior Researcher Emily Carrier, M.D., M.S.C.I.

The study examined approaches to patient and physician engagement in six high-intensity primary care programs in New Jersey, New York, Washington, Oregon, northern California and multiple sites across the Southwest. There are three general approaches to high-intensity primary care: freestanding, practice-based and hybrid models. Regardless of approach, the goal is the same: Targeting high-intensity care to the right patients and motivating physicians to provide that care effectively by working with and supporting the efforts of care coordinators.

The study’s findings are detailed in a new NIHCR Research Brief—High-Intensity Primary Care: Lessons for Physician and Patient Engagement—available online at www.nihcr.org/High-Intensity-Primary-Care. Other key findings include:

### ###

The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nation’s changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is affiliated with Mathematica Policy Research.