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5 Reasons the Employee’s Doctor Should Be Part of Your Employee Wellness Program

Jesse Hercules, President & CEO Extracon Science LLC

The Missing Team Member

Keeping employees healthy and productive is the primary goal of an organization’s wellness program. It’s a team effort.  But most wellness teams are missing an important player – the employee’s primary care doctor.

Onsite screenings may find biometric problems, but it’s the doctor who provides treatment and verifies the problem is resolved. HRA’s may point to gaps in prevention, but it’s the doctor who closes those gaps.  Doctors help patients manage their health – well beyond the items on a screening or HRA.

Research shows that people who have a primary care physician – and work with them on prevention – have lower costs and better health outcomes. 

Why do most wellness programs leave out the doctor? 

Until recently, there was no standard  template for an annual prevention visit.  Doctors weren’t sure if preventive services would be paid for by the health plan. Patients were unsure what their co-pay would be. With all that uncertainty, wellness programs stayed away.

But things have changed.  It’s time put the doctor in employee wellness.

What Problems Does It Solve?

A wellness program that’s designed to include the doctor can solve a number of problems for employers:

Lack of Follow-Up: Onsite screeners and coaches can’t guarantee that biometric problems will be diagnosed and treated by a physician.  Onsite screenings are not coupled to diagnosis, treatment or medical followup.

Prevention isn’t Getting Done:  CDC research shows just 25% of US adults aged 50-64 are up to date on all the prevention recommendations. 

Paying Twice:  Employers are paying for onsite screenings, when many of their employees already get the same screenings at their physician’s office.

Unfriendly Incentive Designs:  Starting with an onsite screening (instead of a physician visit) makes incentives for biometric outcomes less friendly and harder to administer.

Lack of PCP Relationship: Many employees don’t have a primary care doctor, or only see their doctor when they are sick.  That means they’re more likely to be hospitalized or readmitted, more likely to visit the emergency room, and less likely to complete recommended preventive services.

Why Now is the Time

Value-Based Care is changing everything for prevention and primary care.  It puts the primary care physician in the central role of managing the patient’s overall health and prevention. 

Most commercial plans now cover an Annual Prevention Visit – with no co-pay to the patient.  There is now a standard set of CPT codes for doctors to use in billing the visit and related services. 

All employer health plans pay for all preventive services rated A or B by the US Preventive Services Task Force.  The USPSTF recommendations have become the standardized checklist for prevention. 

Electronic Medical Record (EMR) vendors put templates into their software to guide doctors and medical staff through the Annual Prevention Visit and how to tailor it to each patient’s age, gender and other variables.

These changes have removed the uncertainty that kept wellness programs from including the doctor.  They paved the way for wellness programs to include the primary care physician as a true part of the team.

A Process to Build On

Wellness programs that include the doctor need to understand the doctor’s annual process for prevention and wellness.  Let’s take a look:

Annual Preventive Visit:  The annual wellness visit includes a complete physical and a review of prevention status.  The biometric screenings and preventive services are tailored based on the patient’s age, gender, and other factors.   The visit includes USPSTF recommendations that most onsite screenings skip.

If prevention items are due and can be completed in a primary care setting (such as a flu shot), they are completed.  For specialist services like a mammogram or colonoscopy, the doctor makes a referral.

Many patients will need a prescription renewal for common conditions (like hypertension) that are well controlled with existing medication.  These renewals can take place during an Annual Preventive Visit. 

Follow-up Visit:  The doctor follows a set of clinical guidelines for treatment and follow-up of problems found at the Annual Visit. 

For the biometrics that employers screen for (Blood Pressure, Cholesterol, Glucose), clinical guidelines call for treatment with medication and scheduling a follow-up appointment in a few weeks. 

The follow-up appointment includes a re-test to verify that the medication is working.  If needed, the doctor will change the dose or medication and schedule another follow-up. 

How to Work with the Doctor

Here’s a snapshot of how employee wellness programs can get started.

Annual Preventive Visit:  Send your employees to their primary care physician for an annual preventive visit.  The annual visit replaces your existing onsite screenings.  Annual Visits build and reinforce the primary care relationship.

They’ll bring a short, simple Annual Visit Form to the appointment.  It includes:

       Key Biometric levels such as Blood Pressure, Cholesterol and Glucose - and whether they are already under treatment for each.  

       Flagged for Follow-up:  Whether the doctor will start or change treatment for key biometrics.

       Prevention status:  Whether the participant is up to date with the USPSTF recommendations for preventive services.

       Cleared for Exercise / Weight loss:  If the wellness program includes physical activity or weight loss, can the patient meet these goals?

After the visit is complete and any labs are processed, the doctor’s office will Fax the form into the wellness vendor.  

Follow-up Visits:  Employees will bring a Follow-up Form to these visits. 

The form asks about:

       Retest Information:  for the biometric(s) under treatment, results of retesting after treatment.

       Problem Resolved?  Does the doctor consider the problem resolved, or will the doctor order another round of treatment and follow-up?

After the visit, the doctor’s office will Fax the follow-up form to the wellness vendor. 

Specialist Preventive Services:  If the primary care physician refers an employee to a specialist for prevention services (such as a colonoscopy), the employee will bring a Prevention Form for the specialist to Fax into the wellness vendor.

A Better Set of Incentives

Many wellness programs would like to stop paying for participation, and start using incentives to drive results.  They want to drive engagement and real health change – without becoming the biometric police.

Including the doctor means you can have more powerful incentives without rigid biometric standards or an unfriendly appeals process. 

You can have an incentive for participants who are up to date on the USPSTF prevention recommendations, as verified by their doctorThe requirement is tailored to each participant’s unique needs and based on solid EMR data. 

For biometrics like blood pressure, cholesterol or glucose, your incentives are based on whether the doctor says their numbers are right for them.   This means it’s tailored to each participant and you don’t have to deal with exceptions and appeals.

Including the doctor also takes the rework and appeals out of your incentives for validated physical activity and/or weight loss.  You can have an incentive based on accurate App or Device data, knowing that all your participants were pre-cleared by their doctor.

Will Doctors Do Their Part?

Many wellness programs we talk to are unsure if the doctors are willing to participate and send in the wellness forms. 

The answer is yes.  Across thousands of wellness participants, we’ve had a 98% success rate for primary care physicians filling out wellness program forms on the first try.  Most of the remainder are resolved after one patient call.

What’s the doctor’s motivation?  Doctors fill out the form because their patients ask them toIt’s really that simple. 

There’s a process and a precedent.  Primary care doctors have filled out employer forms of various kinds for decades.  It’s a common request that their office staffs handle every day.

It helps their quality metrics:  In today’s world, where doctors are measured on their patients’ prevention compliance – we’re finding doctors are happy to get patients who are part of a wellness/prevention program.

What About Costs?

For most employers, it’s possible to have a wellness program that includes the doctor, using the same budget that’s in place today. 

For the same cost as an onsite screening, a good wellness vendor can manage the process of including the doctor:

       Getting participants ready for their visit

       Collecting data from the Prevention Visit and Follow-Up Visits

       Having health coaches available to assist participants

       Administering incentives and keeping you compliant with HIPAA

       Providing aggregate reports based on the physician data

So the pragmatic approach is to redirect the budget that’s been used for onsite screenings, and use those dollars to include the doctor in the wellness program. 

You might worry about adding more doctor visits onto the health plan.  However, studies show that participants who work with their primary care doctor on prevention have lower overall healthcare costs. That makes it a win/win for the wellness program and health plan.

5 Reasons the Employee’s Doctor Should be part of your Wellness Program:

1. Doctor-Patient Relationship:  Employees who don’t have a primary care physician will benefit from having one.  Employees who have one will start working with their doctor every year on prevention.  The Annual Preventive Visit is the foundation of a good doctor/patient relationship.

2. Better Prevention:  Your rates of completion for preventive services like flu shots, depression screenings, and colonoscopies will go up. Employees and their doctors will review prevention status annually and close any gaps. 

3. Better Follow-up:  When a biometric problem is found, the doctor will treat the problem and schedule a follow-up appointment.  At the follow-up appointment, the doctor will re-test and verify the medication is working. Screening is coupled with diagnosis, treatment and follow-up.

4. Better Incentives:  Starting with a physician visit makes better incentives possible.  You can have incentives for biometric outcomes and prevention status – that are friendly and easy to implement.  

5.  Better Data:  Working with the doctor gives the wellness program access to better data than HRA’s and onsite screenings can provide.

Data on preventive services comes from the electronic medical record – not what the patient remembers when they take the HRA.

Biometric levels are more meaningful when combined with treatment and personalization.  Is that blood pressure reading with or without the use of medication?  Are the current levels the best the person can do?

Having the doctor ask about things like tobacco use or diet will get more meaningful and truthful answers than asking about these issues on the HRA.   

If the participant is treated for common biometrics and goes to a follow-up appointment, the wellness vendor gets the re-test data.   If they go to a specialist for preventive services, the wellness vendor gets that data.

A Word about Promotion and Instructions

Employees need to understand why you’re bringing the doctor into the wellness process, and what they can do to get the most out of their Annual Prevention Visit.

You’ll want to educate participants on how to ask for the appointment and what to say to the front desk on check-in.  They will want to have a list of questions for the doctor:

Questions may include:

       Am I caught up on all screenings and immunizations?

       Do you have any recommendations on how I can improve my health?

       How are my levels for cholesterol, blood pressure and glucose?  What can I do to keep those numbers under control for the future?

You’ll also want to educate on how to avoid turning the Annual Preventive Visit into a sick-care visit.  If they are sick, they should reschedule the Annual Preventive Visit for a time when they are well. 

The right communications are your key to a smooth program rollout.

Some Questions You Might Ask Yourself

       Do I want my employees to have a primary care relationship and to work with their doctor on prevention? 

       How many of my employees are up to date on all the prevention recommendations? 

       If an employee has a biometric issue at a screening, do I know if it was treated by a doctor and resolved? 

       Am I looking for more tangible results on prevention gaps closed and biometrics brought under control?

       Am I looking for a way to tie incentives to more tangible outcomes – employees who are up to date on prevention and whose biometrics are under control?

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