Population Health Management and the Annual Physical Exam

May 4, 2015 / By Steve Delaronde

Population Health Management (PHM) is the application of specific interventions and approaches within a healthcare delivery system designed to improve and maintain the health of a population. PHM strategies should be effective (lead to better outcomes), as well as efficient (achieve the best outcome at the lowest cost). As the U.S. healthcare system continues to promote value-based care and PHM, it’s critical that health systems address the most important issues that lead to the best outcomes.

Are we focusing on the right issues?

According to the Centers for Disease Control, about half of American adults have at least one chronic health condition and one quarter of adults have two or more chronic health conditions. Additionally, more than one-third of adults and nearly 1 in 5 children are obese. These conditions account for more than 75% of healthcare costs.

We know that specific health behaviors are associated with many chronic health conditions, including poor diet, lack of exercise, smoking, and stress. Given what we know about the relationship between unhealthy behaviors and chronic disease, it makes sense to prioritize and address these issues. Unfortunately, our healthcare system remains focused on disease diagnosis and treatment and not health promotion and prevention.

Is the annual physical exam ready for an update?

The annual physical exam is one example of a healthcare intervention that needs improvement. More than 44 million American adults receive an annual physical exam, but its value in producing positive health outcomes is questionable. The Society of General Internal Medicine no longer recommends routine general health checks for asymptomatic adults. There is no evidence that the annual physical exam is effective in reducing morbidity or hospitalization, and it actually creates the potential of harm from unnecessary testing. In spite of this, however, a Kaiser Family Foundation poll found that 92% of Americans think an annual physical exam is important and 62% get one every year. Does that mean that the annual physical should be entirely eliminated resulting in an immediate savings of $10 billion to the U.S. healthcare system? Not necessarily.

While the annual physical exam as it presently exists should be reconsidered, an intervention that focuses on patient behavior rather than lab and diagnostic tests should replace it. The role of primary care is to holistically treat the patient with a focus on wellness and prevention. Since food choice, exercise, and stress management are behaviors associated with physical and mental health, this would seem to be a logical focus of an annual primary care visit.

Using the annual visit to promote health behaviors rather than look for disease, and including nurse practitioners, physician assistants, as well as other health professionals such as health educators and dieticians in this effort, would help address issues of poor accessibility, lack of care continuity, high costs, and unnecessary testing and treatment.

Steve Delaronde is director of consulting for populations and payment solutions at 3M Health Information Systems.