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Rethinking the annual visit

How digital health can improve patient outcomes, one data point at a time

Woman sitting on couch using digital health tools

The norm of the annual visit

Maggie sits down in her sunken recliner, sets her venti caramel macchiato on the side table, and props up her feet. Using her smartphone, she rings her son Nathan. “I just got home from Dr. Garcia’s office, and he says that I have a clean bill of health. Tomorrow, I’ll be fully vaccinated so I’m ready to book a flight to meet my new grandbaby!”

But does Maggie really have a “clean bill of health”? As her primary care provider, that’s not exactly what you told her at her annual exam. During her annual exam, you had her vitals taken, updated her health records, and ordered a routine cholesterol screening. You noted that her blood pressure was a touch high but were unsure if that reading was due to your own presence as a doctor, also known as “white coat hypertension”[1]. Overall, Maggie’s annual didn’t inspire any serious health conversations, but you did remind her to watch her weight—according to her chart, she’s gained about five pounds a year over the past couple of visits. In an effort to educate her on the health benefits of regular movement, you printed out an easy exercise guide for her to take home.

It appears you and Maggie have different ideas of what a “clean bill of health” looks like. Once Maggie leaves your office, the best you can do is hope that she takes your professional advice. And it won’t be until next year that you’ll get a look at Maggie’s health vitals again—unless she has a health emergency in the meantime. Despite your best efforts, Maggie’s yearly appointment may not be impactful enough to prevent chronic disease. In fact, there is professional conversation on the rise about eliminating the annual visit altogether.[2]

Are annual visits effective?

During Maggie’s annual visit, she was flooded with numbers: weight, blood pressure, temperature, heart rate, etc. With this influx of information, it’s easy to imagine she was overwhelmed or even forgot what she was told and what her health data meant. Additionally, if Maggie is like most people, she tends to have an optimistic vision of her health.[3] As long as you didn’t have any threatening concerns, she can’t think of a reason to make a lifestyle change. See you next year, doc!

This thinking not only puts the weight of Maggie’s health on a once-a-year visit, but it also doesn’t empower or encourage her to establish strategic and routine healthy habits outside of your office. Put simply, annual visits may simply not be enough to drive positive health outcomes. Furthermore, many activities within the annual exam lack any evidence of benefit.[4] Harvard Medical School adds to the somewhat controversial discussion, saying that “being seen by your doctor once a year won’t necessarily keep you from getting sick, or even help you live longer. And some of the components of an annual visit may actually cause harm”.[5]

Against this backdrop, the push toward value-based care models continues to gain momentum. Though your medical practice hasn’t fully transitioned to value-based care, the leadership team has started moving in that direction by establishing three goals to improve population health:

  • Identify at-risk and rising-risk populations
  • Design effective interventions to prevent or mitigate chronic diseases like hypertension and diabetes
  • Reduce the number of unnecessary hospital admissions and 30-day readmissions

These goals introduce an interesting conundrum when practicing medicine under the traditional episodic model of care. Maggie is a responsible, reliable patient who schedules her annual physical each year. And yet, that annual visit may not be enough to prevent a serious chronic health event in her future. The limitations of the annual exam lie within its name—you will only collect data from Maggie annually. Without any updates on her vitals throughout the next year, you can only hope that she doesn’t dip into an at-risk population, develop a chronic disease, or take an otherwise avoidable trip to the ER.

From episodic care to continuous care

Let’s take a look at Maggie again. After wrapping up her annual exam, you were hopeful that she’d pay closer attention to her weight and her diet, along with adding some moderate exercise into her daily routine. Little do you know that immediately after leaving the appointment, Maggie hit the coffee shop on her way home and already has her feet up in the air. She also forgot to tell you during her visit that she had a torn retina last year, so her new sensitivity to light has her staying indoors a lot more. Even though you shared an exercise flyer with her, it’s already landed in the junk mail pile on the counter.

It’s clear that Maggie is living a largely sedentary lifestyle, and it’s proven that an inactive lifestyle is a risk factor for hypertension, which can lead to chronic illnesses like heart disease, kidney disease, and strokes.[6] But it doesn’t stop there. With less movement, and an existing weight gain trend, Maggie is also at risk for diabetes. Of course, those sugary coffee drinks don’t help.

As a medical professional, you know that chronic illnesses can often be prevented, but it’s difficult to prevent something if there are no visible warning signs and limited engagement with your patient. Remember, Maggie thinks she received your stamp of approval. By the time you see Maggie again, she may already have hypertension or be prediabetic.

Obviously, there’s a problem. The traditional, episodic model of care fixes problems after they occur: Maggie feels sick, so she makes an appointment to see you. Under this model of care, it’s expensive and unrealistic to see Maggie more than once a year for a physical. How can you keep Maggie on track with her health goals in between visits?

Using digital health alongside annual visits

It’s trendy to be healthy. One in five people use a fitness tracker,[7] and some studies show that people of all generations are willing to pay more for healthier food options.[8] With people actively seeking out ways to improve their health, eliminating annual visits altogether is unnecessary, especially since 54% of US adults make a trip to their primary care doctor at least once a year anyway.[9]

It might be the right time to consider how a digital health strategy can complement your patient’s annual wellness check. Incorporating digital health tools can empower Maggie to take ownership of her health by tracking and monitoring simple vital signs. Better yet, if Maggie uses a digital health tool, you and the rest of her care team could have access to her near-real-time and trending health data—not just the single, yearly snapshot you usually view. With that access to data through remote patient monitoring, you’d have the insight and the ability to intervene promptly if Maggie began developing any negative health issues.

A holistic, data-driven view of Maggie’s health can lead to valuable, actionable insights on the prevention (or management) of chronic conditions. For instance, if Maggie measures and records her blood pressure consistently at home, the emerging trend data can tell you both if she’s at risk of developing hypertension. And if your entire patient population was similarly empowered to track and share their health trend data with you on a regular basis, you’d be taking meaningful steps to achieve the shift from volume to value outlined by your management team too.

The benefits to longitudinal data

If Maggie monitors her health at home, it can help you manage and mitigate her risk for diabetes and hypertension. However, implementing a digital health platform can lead to a multitude of other gains too, such as:

  • Reducing healthcare expenses by decreasing nonessential tests/labs[10]
  • Supporting patient lifestyles that practice preventive versus episodic care
  • Focusing specialized care to at-risk populations through data and analytics
  • Encouraging patients to set up a support system of all their providers to keep them on track
  • Empowering patients to take ownership of their own health—both behaviors and outcomes
  • Reducing unnecessary ER admissions and readmissions

Prevention is just one path to lowering healthcare costs. Studies have also shown that patients who already live with a chronic disease can use digital health to manage their condition.[11] From a population standpoint, there will inevitably be patients with chronic conditions, too.

Maggie is a self-starter and cares about her health. She’s proud to say she has an annual exam every year. But Maggie can’t effectively manage her health from data captured just once a year—and neither can you. It’s time to reimagine the annual visit. Using a digital health approach, you can enable Maggie and all your patients to regularly track their vitals—providing meaningful, actionable longitudinal data to discuss during an annual physical. That could be a game changer for their health—and for the business of healthcare too.

[1] 2 Minute Read Medically Reviewed by Heart and Vascular Institute June 22, 2. (2018, August 29). Is white coat hypertension real? Retrieved September 15, 2021, from https://share.upmc.com/2017/06/is-white-coat-hypertension-real/

[2] Mehrotra, A., & Prochazka, A. (2015). Improving Value in Health Care — Against the Annual Physical. New England Journal of Medicine, 373(16), 1485-1487. doi:10.1056/nejmp1507485

[3] David B. Feldman Ph.D. (2019 February) Is Optimism Ever Unhealthy? From https://www.psychologytoday.com/us/blog/supersurvivors/201902/is-optimism-ever-unhealthy

[4] Horn, D. M., MD, & Haas, J. S., MD. (1970, October 21). Covid-19 and the mandate to Redefine Preventive Care: Nejm. Retrieved October 27, 2021, from https://www.nejm.org/doi/full/10.1056/NEJMp2018749

[5] Amy Ship, M. (2015, October 23). A checkup for the checkup: Do you really need a yearly physical? Retrieved July 08, 2021, from https://www.health.harvard.edu/blog/a-checkup-for-the-checkup-do-you-really-need-a-yearly-physical-201510238473

[6] High blood pressure (hypertension). (2021, July 01). Retrieved July 15, 2021, from https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/symptoms-causes/syc-20373410

[7] Vogels, E. (2020, August 14). About one-in-five Americans use a smart watch or fitness tracker. Retrieved July 14, 2021, from https://www.pewresearch.org/fact-tank/2020/01/09/about-one-in-five-americans-use-a-smart-watch-or-fitness-tracker/

[8] Gagliardi, N. (2015, February 20). Consumers want healthy foods–and will pay more for them. Retrieved July 14, 2021, from https://www.forbes.com/sites/nancygagliardi/2015/02/18/consumers-want-healthy-foods-and-will-pay-more-for-them/?sh=403bdeff75c5

[9] Artandi, M., & Russell, S. (2020, June 18). Telemedicine paradoxically deepened our connections with patients. Retrieved July 08, 2021, from https://www.aamc.org/news-insights/telemedicine-paradoxically-deepened-our-connections-patients

[10] Dorsey, E. R., & Topol, E. J. (2020). Telemedicine 2020 and the next decade. The Lancet, 395(10227), 859. doi:10.1016/s0140-6736(20)30424-4

[11] How digital health care can help prevent chronic diseases like diabetes. (2020, October 29). Retrieved July 08, 2021, from https://hbr.org/2017/11/how-digital-health-care-can-help-prevent-chronic-diseases-like-diabetes

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