Law of Averages: How does it add up to a complete health picture of your members?

I attend a number of industry conferences, and at a recent event hosted by Opal in San Diego, I heard the following:

• The average 75 year old has three chronic conditions and takes five medications
• The average 75 year old Medicare Advantage (MA) member spends 12 hours a year in doctor visits
• The average amount of time a patient actually spends with the doctor during one of his visits is only 13 minutes
• The average 75 year old Medicare members sees between five to seven different doctors a year (whether primary care, covering physicians, urgent care, hospitalists, or specialists)
• To conduct a comprehensive health assessment, a physician needs to spend between 45 to 65 minutes with a MA member

This highlights the need for EMR, collaborative care models, and medical homes. It also illustrates the need for annual comprehensive exams and an engaged model around medical management.

If you do the math, a MA member is spending a mere 156 minutes with physicians each year.  And 55 of those minutes should be spent with some clinician who will collect and record an accurate and updated health picture.  Whether it’s a primary care physician, a specialist acting as a primary care physician, or a physician evaluator in the home, some clinician has to collect this information for each health plan MA member each year.  The challenge is the time differential.

How does the physician morph 13 minutes into 55 minutes? This is probably not a case for efficiency, but a change in scheduling or approach. Whether in the home or in the office, we need to create an environment at least once a year that allows Physicians to do that complete wellness exam or health status evaluation in which they ask questions about everything, from activities of daily living to nutrition to chronic condition to medications to behavioral health.

The next step in beating the averages is using this picture.  This health status report needs to be integrated, not only with all the member’s doctors’ plan of treatment, but also with health plan medical management or perhaps even in the member services department.  We need to find new ways to help the member navigate the healthcare system to survive the law of averages.   

Note: You can join CenseoHealth September 13th to hear more thoughts on integrating risk adjustment and quality of care initiatives during an MCOL-hosted webinar event.  Click here for more details.