The size of a primary care physician practice is a major factor in whether those physicians use care management tools for managing chronic conditions in patients.


Care management tools are most widely used in groups with over 50 physicians and group/staff model HMOs.

In Expectations Outpace Reality: Physicians’ Use of Care Management Tools for Patients with Chronic Conditions from the Center for Studying Health System Change (HSC), researchers found that physicians’ use of tools varies widely even among those measures that have been proven to be effective.

HSC surveyed 7 care management tools:

  • Written materials for patient education
  • Nurse managers to coordinate care
  • Non physician educators
  • Group visits
  • Reports for physicians on quality of preventive care they deliver
  • Reports for physicians on quality of care they deliver to patients with chronic conditions
  • Patient registries.

The most widely used tool is written materials, used by 75% of physicians overall–85% of doctors in groups over 50 physicians, and 96% of doctors in group or staff model HMOs.

The least-likely used tool among all physicians is group visits (with only 20% of physicians using this method). Group visits, however, are widely used (68%) by doctors in group/staff model HMOs.

One of the most striking differences in care tool utilization is with nurse managers and non physician educators, used overall by 31% and 50% of physicians. In group/staff model HMOs, however, nearly 9 in 10 physicians use these physician care-extenders to manage and educate patients with chronic conditions.

The data source for this survey is the HSC 2008 Health Tracking Physician Survey, drawn from the AMA master file of active physicians.

Health Populi’s Hot Points: Chronic health conditions eat up 75% of health spending each year in the U.S. That’s $1.5 billion of national health spending. If physicians increased adoption of effective care management tools, we’d move the needle on health care costs. In other words, we could bend the cost curve — that elusive policy objective Congress continues to quantify, project, and debate.

HSC points out the major obstacle to primary care physicians’ lack of adoption of these tools: insurers rarely reimburse physicians to manage chronic care. The fee-for-service payment regime works against whole health management and collaboration between patients and physicians.

But it’s not only about payments: it’s also about size and scale of the medical practice. The U.S. physician practice structure still features thousands of doctors working in solo/2’s and under-5 physician groups. For these cottage industry-sized practices, scale and productivity requirements disincent adoption of care management tools.

The adoption of EMRs should help, to some extent, in getting smaller practices an infrastructure that enables some of these tools to be adopted such as written instructions and patient registries. However, the adoption of labor such as nurse and diabetes educators wouldn’t be addressed by EMR use. There, scale really does matter — and so cooperation in local markets and the leveraging of technology (e.g., telehealth, virtual visits, among these) could provide the next generation of care management tools that support great physician/patient collaboration and participatory health.

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