ACA-Mandated Health Risk Assessments Need Simplification

Primary care practices are willing to implement behavioral and mental health assessments required by the Affordable Care Act, but lack the resources to do so effectively.

If practices implement the assessments, research shows that the high number of health risks identified will likely stretch many of them beyond treatment capacity. That’s the conclusion of a study that produced two articles published in the Annals of Family Medicine. The authors suggest providers focus on fewer elements of the assessments, as prioritized by their patients, to avoid such overload.

The Affordable Care Act established a Medicare Annual Wellness Visit that mandates the inclusion of routine health risk assessments, but until recently little was known about the extent to which healthcare providers can routinely engage patients, and about the health risks and patient attitudes that will be uncovered.

“Health risk assessments can be effective in identifying patients who are at risk, and primary care practices are promising places to conduct HRAs because of the long-term relationships these doctors have with their patients,” said Alex Krist, M.D., associate professor of family medicine and population health at Virginia Commonwealth University.

“However, conducting health risk assessments and then helping patients improve their behaviors and mental health takes time and a team-based approach. Primary care practices will need help with this work,” said Krist, who is principal investigator of the first article (available here).

The article analyzes nine diverse primary care practices that conducted HRAs with more than 1,700 patients. Most of the practices lacked capacity and infrastructure to maintain the work on their own and none chose to maintain the HRA after study completion. Most sites did, however, integrate elements of the supplied HRA into their workflow.

Implementing the supplied HRA, including clinician counseling, increased the average office visit by 28 minutes.

“These challenges need to be addressed before primary care practices can be expected to conduct health risk assessments as part of routine care, but doing so could help improve health and well-being for patients,” Krist said.

In the next article, researchers described the patient-reported frequency, readiness to change, desire to discuss, and perceived importance of 13 health risk factors identified on the supplied HRA — which was called "My Own Health Report."

Close to 55 percent of patients had more than six risks ranging from inadequate fruit and vegetable consumption to depression, but, on average, they only wanted to change or discuss one of those risks.

“Thus, engaging patients in prioritizing health risks and then focusing on the one to three that are of highest priority may be a more realistic, acceptable, and manageable compromise between neglecting these health risks and trying to address all of them simultaneously,” said Siobhan Philips, assistant professor in the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, who served as principal investigator for the article (available here).

The study was jointly supported by the National Cancer Institute, Agency for Healthcare Research and Quality, and the Office of Behavioral and Social Sciences Research.

Researchers from Carilion Clinic, Fielding School of Public Health UCLA, OCHIN, Texas A&M Health Sciences Center School of Public Health, University of Colorado School of Medicine, University of North Carolina Chapel Hill, University of Texas Health Science Center at Houston, University of Vermont, and Virginia Tech collaborated on the study.