Group medical visits improve metabolic outcomes, increase patient satisfaction
LOS ANGELES — Group medical visits can turn the tide for patients with obesity who struggle to lose weight, offering them the chance to focus more intensely on eating habits and weight loss goals in a more supportive setting, according to a presenter at ObesityWeek.
Ingrid Lobo, MD, an associate professor at the University of Colorado School of Medicine who has led group medical visits for 5 years in clinical practice, said the visits, which typically enroll up to 15 patients at a time for a predetermined number of sessions, are a model that can easily be replicated across many primary care settings.
No single definition for group medical visits exist, Lobo said, though the model has been implemented in managed care settings since the mid-1990s. The main focus of group medical visits has typically been on chronic illnesses like diabetes, asthma, or coronary artery disease.
However, the model translates well for patients with obesity, she said.
Lobo outlined three typical group visit models. The cooperative health care clinic model enrolls “high-utilizing” older adults, who are seen regularly over a given time period. A combination model incorporates medical visits and group education, booked in advance with continuity over a specified time frame. A “drop-in” clinic model allows patients with a particular illness to drop-in during a certain time period on a monthly basis.
“The different model that you develop depends on the disease process you’re trying to target and the patient population and the health care setting,” Lobo said during her presentation. “There are different moving parts to this. It’s not just about patient care. This means that coding [for the visits] can depend as well.”
There are a number of benefits to holding group medical visits for weight loss, Lobo said. Studies show participants in group visits had decreased hospitalizations, emergency room visits and subspecialty referrals, and that improved metabolic outcomes seem to be associated with the group visit curriculum. Visits also result in an overall decreased cost of care and increased provider productivity, Lobo said.
Lobo said that no special billing codes exist for group medical visits, and providers may need to check with each insurance carrier.
A model of support
At University of Colorado Primary Care, Lobo said physician-run group visits utilize the combination model, incorporating allotted times that allow the physician to see any patient individually, if needed, either before or after the group session. The group meets bi-monthly over 3 months for a total of six visits in 2-hour sessions to go over behavior modification. Weight loss medication is not prescribed during sessions and they are not intended as a preparation for any weight loss surgery, Lobo said.
“I’m able to spend this time that most providers don’t have ... and patients really value that time,” Lobo said. “For a nominal co-pay, they have 2 hours with a provider to ask questions. It’s a really wonderful thing for them.”
Over six group visits, participants will keep detailed food logs, discuss their goals and go over real-world techniques for how to improve their choices, Lobo said. Citing her own program, Lobo said she also develops individualized exercise plans for each patient and brings in a psychologist for one session to discuss the link between depression and eating habits.
A maximum of 15 patients are accepted at each site in the University of Colorado program; between six and 12 participants usually attend, Lobo said.
“Patients really love this,” Lobo said. “I can’t emphasize this enough.”
The weight loss group visit curriculum, Lobo said, is based in part with consultations with obesity experts and talking with patients about what they would find most helpful — as well as what Lobo said she would like to see incorporated.
“It was kind of my wish list ... what were the things I wished someone sat down and explained to me?” said Lobo, who also discussed her personal struggle with weight loss.
For a successful group visit program, the person leading the group matters, Lobo said.
“You really need to have someone willing to share, because weight and weight management and obesity ... people get really emotional about it,” Lobo said. “They want to see some feeling there [from the provider]. And remember, every group visit is not the same. Use this model to work for you.” – by Regina Schaffer
Reference: Lobo I. Group medical visits for treatment of obesity. Presented at: ObesityWeek; Nov. 2-6; Los Angeles.
Disclosure: Lobo reports receiving initial funding through a Primary Care Strategic Initiative Small Grant through the University of Colorado Hospital, Department of Medicine and University Physicians Group.