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Editor's Correspondence
June 14, 2010

Clinic-Based Population Management Is Preferable to Health Plan–Based Population Management

Author Affiliations

Author Affiliations: Quality and Safety, Harvard Vanguard Medical Associates/Atrius Health, Boston, Massachusetts (Dr Denberg), and Department of Medicine, University of Colorado School of Medicine, Aurora (Dr Levine).

Arch Intern Med. 2010;170(11):997-998. doi:10.1001/archinternmed.2010.177

Simon and colleagues1 recently reported that automated telephone outreach with speech recognition failed to increase rates of colorectal cancer (CRC) screening among a large number of health plan members. They suggested that future interventions should target both patients and health care providers and address more barriers to screening. We believe that shifting the focus away from health plans to health care delivery systems is the best approach. We recently reported2 on a patient-centered medical home model of care that uses (1) brief, primary care provider review and confirmatory authorization for outreach to patients eligible for CRC screening; (2) clinic-based medical assistants who provide, “on behalf” of their primary care providers, mailed and live telephone outreach to these patients; and (3), for interested patients, the mailing of fecal occult blood testing cards or immediate endoscopy scheduling by telephone without the need for antecedent primary care visits to obtain referrals (thus avoiding ambulatory evaluation and management billing). In a pilot evaluation, approximately 30% of patients completed screening colonoscopy through this program. Although the program did not use a comparison group to evaluate CRC screening uptake over baseline rates and did not incorporate a formal cost analysis, we believe that this type of approach has compelling advantages over health plan–based interventions. Within integrated health systems and, eventually, accountable care organizations,3 these advantages include the ability to mine clinical as opposed to claims data; the harnessing of provider-patient relationships through personalized communication from the health system where patients receive their care; and immediate access to scheduling systems. Because of their intrinsic advantages, we hope private health plans and federal payers will expand value-based contracting and pay-for-performance programs in order to support these types of “in-house” population management programs.

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