Group medical visits: Promising model for achieving the Triple Aim

Originally published by …

The group medical visits model was originally conceived as a model for well-child visits back in 1974.  With the current shortage of primary care and other physicians, along with solid outcomes associated with such group visit models as the Centering Model, group visits are again getting notice and are emerging as a potential part of the solution for the ills of our broken healthcare system.

The standard components of a group visit program include:

  • Patients meet as a group, with a clinician (physician or nurse practitioner) and in some cases with a nurse and/or behavioral specialist
  • The group visit is much longer than a standard office visit, i.e., 90 minutes or longer
  • The group visit includes an individualized medical review, patient education, and group discussion

To date much is written about how group visits positively impact the financial condition of a healthcare practice. But when group visits are done well, healthcare finances are not the only thing to improve.  This unique model of care also:

  • empowers patients and families
  • engages and “activates” patients
  • improves health outcomes
  • increases the satisfaction of patients, families and health care practitioners, and
  • in some cases reportedly decreases inappropriate utilization and healthcare costs.

For six years I was the Executive Director of a small non-profit research institute, innovation laboratory, and healthcare organization. There, we offered an innovative group medical visit program for our pediatric patients and families entitled CircleCare™ for Kids that focused both on parents and children and offered patients a blend of group visits and individual sessions.  This program was based on the Centering Model where patients and families engage with each other and with their practitioner in facilitated discussions.  Similar to the Centering Model, CircleCare™ for Kids  brings together patients and families for mutual learning, sharing, and support.

We found that these group visits remind patients that they are not alone; that they are part of a healing community which includes authentic connection, relationship, and trust with multi-directional support.  Questions such as “Has this happened to you?” “What do you do in this situation?” “How do you feel about it?” “How do you deal with fear?” are asked and answered within the safe space of the community.  Humanity is brought back into healing and bonds are created that last over time.

So what does a more advanced group visit look like?  Using the Centering Model as an example, this model includes thirteen essential elements critical for optimal outcomes:

  1. Health assessment occurs within the group space.
  2. Participants are involved in self-care activities.
  3. A facilitative leadership style is used.
  4. The group is conducted in a circle.
  5. Each session has an overall plan.
  6. Attention is given to the core content, although emphasis may vary.
  7. There is stability of group leadership.
  8. Group conduct honors the contribution of each member.
  9. The composition of the group is stable, not rigid.
  10. Group size is optimal to promote the process.
  11. Involvement of support people is optional.
  12. Opportunity for socializing with the group is provided.
  13. There is ongoing evaluation of outcomes.

Group visits done well improve patient and physician satisfaction, improve clinical outcomes, and save healthcare dollars.  Group visits done well improve care and create a space for relationship, empathy, and compassion in healing.  Group visits done well bring humanity back into healing.  The group care model done well will also help us to achieve the triple aim…

1. Improving patient and physician satisfaction:
A study of older patients with chronic illness concluded that group visits for chronically ill patients increased both patient and physician satisfaction.

2. Improving the health of populations:
Another study showed that group prenatal care can improve pregnancy outcomes in the area of reducing preterm births and increasing breastfeeding initiation, psychosocial function, and patient satisfaction, without incurring any additional costs over standard care.

And in fact, in 2013 the Center for Medicare and Medicaid Services (CMS) recognized the Centering Pregnancy® program (of which again CircleCare™ for Kids was modeled after) as an evidence-based care model for the prevention of preterm birth.

In an Italian study that randomly assigned more than 800 Type 2 diabetes patients to either group or individual care, the group patients had lower blood glucose, blood pressure, cholesterol and BMI levels after four years than the patients receiving individual care.

3. Reducing Cost of Healthcare:
The same study of older patients with chronic illness mentioned above also concluded that group visits for chronically ill patients reduce repeat hospital admissions and emergency care use, reduce cost of care, and deliver certain preventive services more effectively.

…and isn’t that why we are all here?

A note of caution: I have witnessed firsthand that group visit models done well and for the right reasons provide short- and long- term benefits for patients, families, practitioners, communities and the healthcare system at large. But not all group visit programs are alike.  When not done well, the group visit model can be abused, typically in an effort by a healthcare organization who has lost their mission focus to “extract additional financial impact” without providing adequate resources for the program.  When attention is focused on maximizing revenues, attention is drawn away from what is truly important, the care of the patient.

Want to innovate healthcare and achieve the triple aim?  Develop and implement well-done group visit models.

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