Accountable Care, Medical Homes and Employers – Do Physicians “Get” the Concept of Providing Value?

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Ok…here’s a brain teaser.  What medical condition is the most costly to employers?  I’ll give you a hint.  It is also a medical condition that is likely to go unrecognized and undiagnosed by primary care physicians.

If you guessed depression you are correct.  If you mentioned obesity you get a gold start since that comes in right behind depression for both criteria…at least in terms of cost and the undiagnosed part.

Four out of every ten people at work or sitting in the doctor’s waiting room suffer from moderate to severe depression.  Prevalence rates for depression are highest among women and older patients with chronic conditions.  Yet despite its high prevalence and costly nature, depression is significantly under-diagnosed (<50%) and under-treated by physicians.

Cost of Depression

For employers, the cost of depression cost far exceeds the direct costs associated with its diagnosis and treatment    As the graphic above indicates, the cost of lost productivity for on the job depressed workers (Presenteeism) and lost time for depressed workers that are absent from the job (Absenteeism) far exceed the cost of cost of treatment (medical and medication cost).

Since I first addressed depression in an earlier post, I have identified what I believe to be the central reason why depression continues to go undiagnosed and untreated in primary care.   The reason is that physicians are uncomfortable talking to patients about it, e.g., psychosocial issues.   Even when patients provide “cues” suggesting evidence of depression in the opening statement, i.e., I have been sleeping well, I haven’t been myself lately, etc., evidence suggests that physicians are likely to simply not recognize or ignore the cues.   Physicians themselves admit that their training predisposes them to be more comfortable dealing with biomedical versus psychosocial issues.

Now think Accountable Care Organizations and Medical Homes.  Both of these concepts, one a payment reform model and the other a delivery model, are predicated upon the notion that the medical services offered have real value to the payer, e.g., employer or health plan.  But what kind of value are primary care physicians providing when they fail to diagnose and treat the biggest problem facing the people that ultimately pay for their service?

Tying this all back to physician-patient communications, physicians need to begin employing more patient-centered communication techniques in their dealing with patients.  In particular, physicians need to do a better job listening to what their patients are trying to tell you, even if it is outside your comfort zone.   At the very least you can refer the patient to a counselor for help.  In so doing you will be clearly helping the patient and adding real value to the people who ultimately pay for your valuable service.

That’s what I think.  What are your thoughts?

Source:

Sherman, B., et al. Patient-Centered Medical Home and Employer Metrics. Patient- Centered Primary Care Collaborative

1 Comment

  1. Patricia Stern says:

    Physicians who are uncomfortable with their own emotional states are much less likely to want to broach topics related to depression with their patients. It’s almost unfair to ask it of them.

    Perhaps we need to start by facilitating comfort and even intra-personal exploration with physicians so that they can feel at home with their own feelings. This is not outcomes oriented information and not what is emphasized throughout their schooling so it may be uncharted territory but once physicians can explore it for themselves they will be much more comfortable being able to explore it with their patients.

    Now all they need is extra time!

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