Earlier this month, the Daily Briefing published findings from the debate surrounding the efficacy of annual checkups. For years, academic studies have questioned the clinical necessity of the annual visit. Perhaps the most compelling was a longitudinal 2012 British Medical Journal study that found no impact from annual visits on patients' long-term mortality, morbidity, or number of hospitalizations compared to a control group.
Primary care resources
Combine that with the difficulties primary care practices face today in achieving scale, and you can see why some leading organizations have started to rethink the practice of annual checkups. Especially as primary care becomes increasingly segmented based on the type of patient, providers are scrutinizing practices that may cause resources to be devoted to patients who don't necessarily need them. And some are making broad changes. For instance, in our 2013 research study, Playbook for Population Health, we reported that Kaiser Permanente Northwest moved towards biannual checkups for healthy adolescents (but they still send annual visit reminders for adolescents with chronic illnesses).
Fewer checkups? Move cautiously.
However, I want to urge caution when moving in this direction. Some experts emphasize the role that annual checkups play in developing and sustaining trusted relationships between patients and providers is an important one. A lack of trust is often a root cause of poor primary care utilization, and annual checkups are one important way to build trusting relationships. Not to mention, checkups are also an ideal time to understand patients' social determinants of health. As more providers begin embedding social determinants screenings in primary care waiting rooms, they may lose an opportunity to track these important metrics. Providers need to keep in mind the patient population they serve and how activated they are before moving away from an annual checkup model. My biggest concern is that we may inadvertently disrupt primary care relationships for patients who already have poor access to primary care, where we should actually be ensuring good access for them.
While I agree that biannual visits can bring efficiency to practices, providers should only prioritize patients who are healthy, well-managed, already activated, and have no psychosocial risk factors. If providers move to this model, they need to ensure that they continue to:
- Power their patient portals or CRM systems to engage these patients between primary care visits;
- Arm patients with information on what to do in the face of acute care flare ups;
- Remind patients about preventive care steps (e.g., flu shots and medication for seasonal allergies);
- Track key care gap information; and
- Make themselves easily accessible for when patients have questions.
Aug. 20 webcon: Global perspectives on primary care
Understand how U.S. providers' comparable investments and strategies in primary care can help them succeed in a world that prizes population health management.