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

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

NIHCR Research Brief No. 9 | October 2012 | By Tracy Yee, Amanda E. Lechner, and Emily Carrier

A subset of patients with complex or multiple chronic conditions -- including diabetes, congestive heart failure, obesity and depression -- accounted for a disproportionate share of costly emergency department visits and hospitalizations. A handful of care delivery models had emerged that offered these patients high-intensity primary care designed to prevent avoidable acute episodes. Early assessments showed promise, but the success of these programs hinged critically on engaging both physicians and patients in sustained participation.

Engaging Physicians in High-Intensity Programs

Physician engagement depended on several factors identified through HSC's qualitative research. Financial commitment and administrative support from health plans were essential -- physicians needed to see that the sponsoring organization was serious about the program and willing to invest in making it work. Well-designed financial incentives tied to quality and outcome improvements helped motivate physician participation beyond the initial enrollment phase. Allowing physicians to help identify which of their patients would benefit most from intensive primary care improved physician comfort with the program and increased buy-in from the start.

Strategies for Patient Engagement

Getting patients to participate actively in high-intensity primary care programs required different approaches. A personal invitation from the patient's own physician proved to be one of the most effective recruitment tools -- patients were far more likely to enroll when their trusted doctor recommended the program directly. Once enrolled, rapid access to physicians and care coordinators helped sustain patient engagement by demonstrating immediate, tangible value.

Programs that made it easy for patients to reach their care team -- through same-day appointments, extended office hours, telephone access and home visits -- reported stronger patient participation rates than those that operated on traditional scheduling models. The convenience factor mattered especially for patients managing multiple chronic conditions, who often faced significant logistical barriers to attending frequent medical appointments.

Potential for Cost Savings and Quality Gains

While high-intensity primary care programs required greater upfront investment per patient than standard primary care, the potential returns came from reducing expensive downstream utilization -- fewer emergency department visits, fewer hospital admissions and shorter hospital stays. The economic case for these programs rested on the ability to identify the right patients, engage them effectively and sustain their participation long enough for the investment to pay off through reduced acute care spending.

Sources and Further Reading

This research was originally published as NIHCR Research Brief No. 9 through the National Institute for Health Care Reform, affiliated with the Center for Studying Health System Change.