According to Vivek Garg, M.D., CMO of Humana’s Primary Care Organization, there’s a need for new models of care that can reduce PCPs’ caseloads and address the unique needs of older patients.
By Dr Jay Feldman, M.D., MBA, Chief Medical Officer of Humana’s Primary Care Organization
The pandemic revealed serious flaws of healthcare systems in the U.S. healthcare system that existed long before the outbreak of Covid-19. These issues include excessive levels of burnout, attrition among primary care doctors (PCPs), and the severe vulnerability and health issues of many older Americans.
The decline of the primary care system in our country has had a huge impact on older adults. Primary health care is the most powerful and under-funded tool to reduce the risk of disease, enhance health, and reduce the mortality rate. However, it is the case that the U.S. spends only 5-7percent of its health care dollars on primary health care. Spending is less for seniors, the poorest and most chronically sick group.
The consequences of this insufficient investment in primary health care are extremely significant. When the pandemic hit, patients suffered poorer health and outcomes, particularly those with lower financial situations.
This has made some primary care physicians’ job roles unsustainable, leading to an over-burdened patient load and insufficient time and resources to concentrate on the individual needs of patients and the many issues that affect their health. This has led to the fact that many PCPs are unhappy with their careers in medicine and others who are leaving the profession completely. In reality, a declining percentage of medical students opt to focus on primary medical care as a first step. This is all happening while the baby boomers age and the need for direct health care services are increasing.
There is a need for new models of healthcare that reduce the number of PCP patients and administrative burdens while also addressing the diverse social and health requirements of older patients, especially those in under-served communities. The good news is that there are alternatives that work. Based on a value approach to providing community-based primary care for seniors, the care team is showing benefits for both the clinicians and their patients.
Effective health care requires more than just medical care.
To ensure that you are providing effective healthcare, it is essential to connect with patients in terms of everyday life – understanding the communities they live in and comprehending and addressing the many aspects that impact their health. An earlier investigation conducted by Humana released in Health Affairs found that half of Medicare Advantage participants in a nationwide survey stated that they had at least one social need. Many needed multiple services; one-third had financial difficulties, 18.5% had food shortages, and 17.7 percent reported inadequate housing. Many seniors are also unable to access transportation, which hinders them from accessing essential items and medical treatment, as well as causing their isolation to increase.
Not recognizing these realities and focusing solely on the patient’s medical requirements is not a good idea for medical treatment. Clinical care is only responsible for 20 percent of health outcomes; however, 80% result from social factors that affect wellbeing (SDOH) – the social and environmental factors that affect a patient’s wellbeing. Physicians are fully aware of the non-medical effects on health. According to a Physicians Foundation survey, most physicians are aware of SDOH’s influence on the outcomes of patients. But there’s a huge gap between their practices and knowledge, and just 15% of doctors screen for those issues.
The causes behind this division are simple: doctors often don’t have the resources and knowledge to offer solutions to their patients. They also use the fee-for-service model that does not consider all aspects that could impact a person’s health.
But this is beginning to alter. Recent changes in Medicare Advantage programs have broadened the scope of supplemental benefits to meet a wide range of social service requirements; the trend toward value-based healthcare has significantly increased the importance of SDOH in treating patients, given their significant impact on health outcomes.
The Difference, a Care Team, Can Make
A comprehensive, all-encompassing approach to healthcare requires a group of professionals who can meet the patient’s social and medical requirements and a payment system that recognizes them for the high quality of the care they offer and not the number of services they provide.
It is also a matter of establishing a relationship based on trust between patient and doctor that can only be created when the clinicians spend enough time with their patients to have meaningful conversations take place, sharing the everyday and personal issues they face with their patients. A 15-minute session isn’t enough for these relationships to grow. However, the way most practices are run today, doctors have more to do than they have time. According to studies on physician time pressures, Primary care physicians have to work 18 hours a day to complete all of their duties, which leaves only a few minutes for each visit with a patient.
With the help of a group of specialists, which includes nurses, pharmacists, and social workers, as well as behavioral experts, the doctor not only can spend more time with their patients and their families, but the team is also able to take care of a wide range of needs for patients that a physician on their own can’t possibly handle.
One example of this method can be seen in Humana’s primary healthcare centers that including The CenterWell Senior Primary Care and Conviva Care Centers, which are situated mainly in areas that are not well-served. The value-based care team model has drastically reduced the size of physician panels, allowing PCPs to spend, on average, 40 minutes with patients and increase their frequency. These more extended and consistent visits enable physicians and health professionals to understand the patient’s personal situation and to provide the complete range of services they require.
Connecting Seniors to Mental Health and Social Services
The most crucial aspect of improving the health of older adults is focusing on their emotional and psychological well-being. In the United States, at least one out of four elderly adults living the U.S. suffers from mental health issues, and that figure is expected to increase by a factor of two over the next 10 years. A poor mental health condition among older adults with chronic diseases may hinder their compliance with treatments. It can worsen physical health problems and result in a lower quality of life and worse outcomes. Additionally, it can result in substantial medical expenses.
Despite the widespread incidence of mental health disorders within this group, older people are 40 percent lower likely to take advantage of or receive treatment for mental illness than younger people, and up to two-thirds (or more) of seniors suffering from mental health issues don’t receive the needed treatment.
The barriers to treatment are numerous and complicated. When Dr. Jordan Sudberg have more time with their patients, they are better equipped to detect potential mental health issues and provide access to services for mental health when a therapist is a key member of the team of primary health care providers, which eliminates significant obstacles in the treatment process.
Finding the best health care for patients takes effort, time, and connections to the community where the patient is. That’s why it’s essential to employ a social worker as part of the care team. They’re the best trained to comprehend the unique demands of patients’ social services and build relationships with local resources. They use these connections to tackle problems of daily life that hinder individuals from attaining healthy and optimal health.
We’re beginning to see the benefits for patients of the value-based health team approach. Recent JAMA research discovered that this model’s primary-care practices reduce emergency department visits by more than 13 percent and hospitalizations by nearly 6 percent.
The reduction in hospitalizations means more time seniors can be at home doing the things they love to do while staying in touch with their loved ones and family. As a doctor, I believe that we’ve done our duty when we assist our patients to enjoy a better standard of living. As a result, we can help create a more attractive and rewarding profession in a time when it is in such dire need.
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