Tuesday, May 7, 2013

The Future of Health Risk Assessments: The Good, The Bad and The Ugly

Health Risk Assessments: The Good, The Bad and The Ugly
Kameron Gifford, CPC
The Hippocratic tradition emphasizes prognostication and prevention, using patient-centered regimens of dietetics and exercise to maintain or regain health. It was this belief from fifth century B.C. that created the foundation for modern medicine.

In the 1960’s, literature was published confirming this idea and the practice of assessing health risks became an inherent part of primary care.

Employer sponsored health plans first began experimenting with these types of “interventions” over 20 years ago. Although the programs varied tremendously, the results were the same: a greater number of positive outcomes.

Patients were happier and healthier, providers felt they were providing better care and surprisingly the cost of care decreased.

A recent study be the CDC confirms that health promotion and disease prevention programs directed at a working age population produced cost savings. A meta-analysis showed that these programs achieve a medical cost saving of $3.27 for every $1.00 invested in health promotion activities.

With all the empirical evidence that supports whole system, patient focused care, it makes sense to apply these practices to our most vulnerable patients. Chronic illnesses account for an estimated 83% of total U.S. health spending and virtually all (99%) of Medicare’s expenditures are for beneficiaries with at least one chronic condition. Among adults aged 65 years and older, only 33% of women and 40% of men are up to date with all age-specific recommended preventive services, and fewer than a quarter of adults aged 50 to 64 years are up to date in receiving these services.

All of this considered, HRA’s should provide a valuable tool for clinicians to engage patients and provide tangible feedback on improving their health. But that is not the case.

I have reviewed more than 5,000 HRA's from all of the major health plans and none of them add meaningful value to either the patient, the provider or the experience of care.  What will?

CMS must stop allowing health plans to submit diagnoses for the sole purpose of enhancing their revenue. The entire idea that a plan can manipulate their reimbursement for "care" solely through a process of providing diagnoses codes (not any treatment) obtained through a third party CREATES gaps in care.

Our office fields phone calls daily from patients with concerns about home based HRA’s. The majority of patients are not happy. They are confused about why their insurance company is sending someone to their house, many of them are nervous because they live alone or don’t understand the reason for the visit. The information that they are getting is incorrect and often dangerous. I can vividly recall 3 different diabetic patients who were told to stop their insulin because "they weren’t diabetic". After learning of this I immediately notified the “third party contractor” who was not the least bit concerned about the incidence or the probable negative outcome for my patient. And why should he be? His company is getting (on average) $400 for each home visit and questionnaire turned in. His payment is not dependent on the patient experience, the accuracy of the information or the treatment of any "problems" identified.

CMS has recently voiced their concerns over this activity and I suspect that Medicare Advantage plans will be required to flag these in diagnoses in 2014 with some kind of financial impact in 2015. 

Start Planning Now...

An effective health risk assessment adds value and improves outcomes for all stakeholders. 

Don't wait until the federal mandate next year, start creating meaningful process to track, treat and monitor all diagnoses identified on an HRA's.

4 Characteristics of Effective Health Risk Assessments

  •  Create patient centered solution teams that work together to improve outcomes.
    • Assess, Design, Measure, Improve
  • Incentivize Primary Care Provider’s for performing Health Risk Assessments. 
    • Communication builds trust. Trust builds relationships, and relationships provide the necessary catalyst for changing behaviors.
  •  Be flexible in your generating feedback. Support the process with meaningful engagement and personalized interventions.
    • Embrace unique perspectives / Look outside the box!
  • Measure and Re-measure at key milestones to determine effectiveness and guide program modification needed to ensure a positive experience for all stake holders
    • Continual commitment to innovation

For more information or to find out how we can help, please visit www.ermconsultinginc.com

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