Engaging both physicians and patients is key to treating those with complex conditions, according to a recently released study.


Hospitals have made efforts to treat patients with certain complex or chronic conditions — such as diabetes, congestive heart failure or obesity — through so-called "high-intensity" primary care. Such programs pour extra resources into the patient early on to try and improve quality and lower costs in the long run.

But those efforts are destined to fail without engaging both the physician and the patient, according to a qualitative study by the Center for Studying Health System Change, commissioned by the nonprofit National Institute for Health Care Reform.

High-intensity primary care usually involves physicians, supported by care coordinators who help patients navigate through the system and stick to their treatment plans. It comes in three different types of models — freestanding, practiced-based or a hybrid of the two, according to the study.

The analysis found promise in high-intensity primary care after studying programs in New Jersey, New York, Washington, Oregon, California, and parts of the southwest. But engagement was the key ingredient to success.

Here are some other findings:

  • Having payers that are committed to such high-intensity programs is also key to the equation, according to the study.
  • Engaging physicians can require a wealth of resources. Programs had to invest heavily to recruit PCPs to participate, and looking for those in independent practices took about three to six months.
  • Identifying the right patients for high-intensity primary care early on is also critical, the study found. Physicians expressed frustration and lost trust in programs when, based on health plan data, patients were included whom doctors did not deem as "high need."
  • Physicians were initially reluctant to delegate tasks to care coordinators. But as those workers built rapport with the patient and assumed certain tasks, PCPs gradually saw the benefit of relinquishing some control.
  • Patients also have reluctance to try high-intensity primary care because of a lack of knowledge or experience with such models. Respondents were much likelier to participate if the physician explained the advantages.
  • Patients valued "rapid access" to their care team, according to the study, with direct access to the care coordinator via phone or email, allowing them to easily schedule appointments, follow up on test results, or speak with their physicians.