Eliminating hypertension patients’ co-payments for follow-up doctor’s visits and giving them easy-to-use medication could help dramatically reduce their blood pressure, according to an analysis of a large-scale program by medical provider network Kaiser Permanente. If similar programs were implemented on a national level, Americans’ rates of hospitalization and risk for having heart attacks or strokes could be cut sharply.
As many as one in three American adults have high blood pressure, according to the Centers for Disease Control (CDC). The chronic condition commonly referred to as the “silent killer” can lead to costly and even fatal consequences such as heart attack and stroke. Direct U.S. health spending for hypertension is about $43 billion per year, but is likely a much higher figure when factoring in the previously-mentioned blood-pressure related health problems.
In order to combat the rampant condition, the Kaiser experiment was launched in 2001. It involved nearly 2,000 primary care doctors treating 235,000 patients with hypertension or pre-hypertension, and the doctors created a database of those patients to track their blood pressure over the course of the decade. While less than half of the initial participants had their blood pressure under control at the program’s outset, a staggering 80 percent had manageable blood pressure by 2009 — despite the fact that the doctors had added over 100,000 new patients to the registry by then. The numbers improved even further in 2011, even though the program was no longer in effect at that point.
Although researchers couldn’t pinpoint one definitive reason for the reduction in patients’ blood pressure, they suspect that it stems mostly from two critical modifications made to the program in the mid-2000s. In 2005, physicians switched the medication they prescribed their hypertensive patients from a two-pill combo to a single, easy-to-use generic pill. In 2007, Kaiser Permanente began offering program participants follow-up visits with physicians’ assistants — which, unlike regular doctor’s visits, don’t require co-pays and give patients more flexibility in scheduling conveniently-timed appointments.
“Patients really liked it because it was shorter, more convenient, and more affordable,” said lead study author Dr. Marc Jaffe in an interview with USA Today.
Previous research has shown patients who improperly use their medication are major contributors to runaway health care costs. Failing to comply with treatments can make underlying conditions like hypertension even worse, and simplifying the drug treatment itself can go a long way toward eliminating that problem.
Ensuring that a patient is actually taking his or her medicine and making lifestyle adjustments that could reduce blood pressure is also critical to the effort. Follow-up visits provide an easy way to do this — but many Americans forgo them because of the financial hassles of a co-pay and the inconvenience of scheduling an appointment. Unfortunately, avoiding a follow-up is bad news for both patient health and medical spending. A 2010 study in the New England Journal of Medicine concluded that the higher a co-pay, the less likely a patient is to visit a doctor’s office and the more likely he or she is to wind up getting hospitalized for a serious condition that could have been prevented by regular follow-ups.
Implementing programs like the Kaiser blood pressure experiment throughout the country could be a boon to general wellness and American health costs. Obamacare may actually help the medical industry embrace such efforts by encouraging collaborations between doctors, hospitals, physicians’ assistants, nurse practitioners, and pharmacists that are responsible for actively monitoring patients’ ongoing medical needs and making sure they’re following through with their treatments. There is even evidence that these changes have already begun taking place.