Care Coordination Helps Physicians Advocate for Their Patients

Results of a recent nationwide survey by the Partnership to Fight Chronic Disease (PFCD) reveals that nearly eight out of every 10 people (77%) have experienced, or know someone who has experienced, trouble using their health insurance in the past year.

That’s a troubling statistic, says Ken Thorpe, PhD, the Robert W. Woodruff professor and chair of the department of health policy and management in the Rollins School of Public Health of Emory University in Atlanta, GA. And it’s troubling beyond the usual factors of rising insurance premiums and increasing out-of-pocket expenses.

“My concern with this whole thing is that rising out-of-pocket costs for patients who have four or five chronic conditions, the data shows they are less likely to refill their prescriptions,” Thorpe explains. “Ultimately, that has an adverse effect on their healthcare.”

This is where physicians need to serve as advocates for their patients.

Physician awareness

The survey further revealed that half of respondents experienced situations where the treatment the doctor recommended was not covered by insurance. And nearly 60% indicted their health insurer covered less than expected of the cost of care, leaving them with an unexpected medical bill. Are physicians aware of these challenges? Thorpe says, not always.

“We know that about half of prescriptions go unfilled,” he says. “And I’m sure most physicians are not aware of that.”

Thorpe says these situations are most pervasive among patients with multiple chronic conditions. This population is hospitalized more often, and frequently ends up in emergency rooms following initial physician visits. Eighty-two percent of healthcare spending, Thorpe says, is linked to chronically ill patients.

“We did some tabulations for seniors in particular who have four or five chronic healthcare conditions,” Thorpe says. “Each dollar increase they have to pay out-of-pocket increases total Medicare spending by $1.80.”

Physicians becoming advocates

Thorpe offers several suggestions for how physicians can become stronger advocates for their patients and thus alleviate some of these care issues. The first change, he says, is to stop charging high costs for patients with multiple chronic health conditions. He believes that gets in the way of good care because patients are less likely to fill prescriptions.

“As we think about reforming the design of health insurance, having the same co-pays and same deductibles across the board probably doesn’t make a lot of sense,” Thorpe says. “Certainly for clinically recommended treatments of diabetes or hypertension, in my view, there shouldn’t be cost sharing. Take the financial roadblocks out of the way.”

The second suggestion focuses on developing more team-based care approaches, with nurses and nurse practitioners working closely with physicians to make sure patients stay on track after they leave the medical office.

“That’s the real challenge,” Thorpe says. “Because once the patient leaves, for the physician, it’s on to the next patient.”

These suggestions are not theories, however. The PFCD is executing these care coordination teams in different states, Vermont being the first. Thorpe says physicians there are relieved knowing they have someone they can hand the patient off to who’s well-trained and experienced in making certain the patient stays on track.

“Physicians are the experts in coordinating care,” he says. “And they’re helping people execute a plan.”

Financial impact

The healthcare industry is transitioning from a fee-for-service model to value-based care, where keeping patients healthier, and reducing hospital admissions and re-admissions will impact physician reimbursement. Better care coordination of chronically ill patients can go a long way toward achieving that goal.

“Some of the anxiety [among physicians] is that once the patient leaves your office, he or she is out of your hands and out of your control,” Thorpe says. “So that’s why if we’re going to move in this direction—which we are—there is a necessity to build up the care coordination structures.”

The first step, Thorpe says, is a change in mindset for physicians to understand that they’re managing a population of patients in their practice, rather than thinking one patient at a time. When Vermont physicians who are beginning to embrace a care coordination strategy were asked what percentage of their patients has their blood sugar under control, they over-estimated it by a factor of two.

“Having that data available when you’re doing population-based or practice-based profiling in diabetics and hypertensive patients really is an important first step,” Thorpe says. “It will show the gaps, and it will show where they need to spend some of their time and attention, targeting certain patients to be more compliant in their adherence.”