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Two articles published by a VCU School of Medicine professor show that Health Risk Assessments required by the Affordable Care Act could be beneficial to patients, but may place strain on the primary care providers who conduct them.
In 2010 when the 111th Congress passed the Affordable Care Act, informally known as “Obamacare,” the legislation required Medicare patients to undergo an annual Health Risk Assessment. This implementation is intended to preemptively screen for unhealthy behaviors and mental health concerns such as smoking, poor diet, depression and anxiety.
“That’s not part of routine primary care, so even though doctors care about these things, they don’t do this as part of every visit,” said Alex Krist, the family practice doctor and VCU professor who authored the articles.
The purpose of the study, which underscored Krist’s articles, was to determine if primary care providers had the resources necessary to field the assessments and observe their impact on patients.
The study collected data on nine primary care providers who each saw at least 300 patients. According to the articles, the study found the assessments are effective in singling out health concerns, but conducting the assessments can be taxing on health care providers.
“HRAs hold great promise for primary care,” Krist’s first article stated. “The high prevalence of unhealthy behaviors and mental health concerns that we observed is supported in the literature.”
Krist’s second article found that patients exhibited an average of six unhealthy behaviors and mental risk factors.
The most common problems were diet, weight, depression and anxiety. Krist also found that patients don’t necessarily want to change these habits. The study states that on average, patients only wanted to change 1.2 and discuss 0.7 of the risks identified during screenings.
“If you think about these issues — things like depression, diet and expercise — these are difficult things to change,” Krist said. “Merely asking patents if they have these risks will not be enough, and we never expected it to be enough.”
Krist said this is where the problem lies for primary care providers. While they have the ability to conduct a Health Risk Assessment, they struggle to implement the necessary continued coverage.
Krist said that since publishing his articles, primary care providers have expressed a need for better connection among them, which is where Krist thinks health systems, like the VCU Health System, can take initiative.
“They can create a more packaged delivery system,” Krist said.
Large health systems already have access to primary care, dieticians, psychologists and other practices, so the transfer of care from one provider to a larger system could be relatively smooth, he explained.
The other problem the Health Risk Assessments create for providers is a staffing issue. Krist said that asking the required questions and following through on the findings for the average Health Risk Assessment screening adds 28 minutes to each doctor visit.
“Our hypothesis, which I think this still stands, is that this is a good thing to do in primary care,” he said.
Krist said the system will need support if it is going to function with an acceptable standard of efficacy, however. He said consistent funding and improved electronic record sharing between care providers is necessary for the easy transition and continuation of care.
Even if those changes are made, Krist said there is another area of concern: making mental health a bigger part of primary care.
“They’re in really separate silos,” Krist said. “That’s a much bigger problem that needs to be fixed.”