1. Wellness Group Visits: Development and Implementation Randall T. Forsch MD MPH University of Michigan November 19, 2006

5. Objectives

6. Group Visits

7. Characteristics of Group Visits Limited number of dedicated patients ( 10-15 and their S.O.s) Regular meeting time and place Structured visit timetable (90-120 minutes) Education with facilitated discussion Individual physician care Ongoing process, not static or disconnected Measurable outcomes

8. Ethical Issues about Group Visits Patient confidentiality (consent form) What about spouses and significant others in attendance? Change in paradigm from focusing on individual patient to group of patients, “That’s not what Galen/Osler/Marcus Welby MD taught me.”

9. Why do Group Visits? Improves patient care and outcomes Improves patient satisfaction Change of pace Increases clinical efficiency (10 plus visits in 2 hours or less) Billable services Part of the New Model of Family Medicine

10. WHO Wellness Definition Wellness is the optimal state of health of individuals and groups. There are two focal concerns: the realisation of the fullest potential of an individual physically, psychologically, socially, spiritually and economically, and the fulfilment of one’s role expectations in the family, community, place of worship, workplace and other settings. WHO, accessed October 30, 2006

11. Metabolic Syndrome

12. Wellness Group Visit Purpose

13. Necessary Resources Physician interest Interested patients Patient lists by age, DX Space Clerical and MA staff time Facilitation skills Health education expertise and resources, i.e. A/V supplies

14. Structure

15. Challenges

18. Frequently Asked Questions

19. What is a wellness "group visit"? A "group medical appointment" or group visit is a way to receive your medical care along with other patients who have the same conditions or health concerns by seeing your doctor at the same time. The group medical appointment allows the doctor to answer many questions at one time, since patients often have the same questions about improving their health. In addition, patients frequently learn from one another's shared experience. This is a new type of appointment which emphasizes self-management and helping patients improve their health and quality of life through nutrition, exercise and other important lifestyle changes.

20. How does a wellness group visit work? You will have a scheduled appointment, initially once a week for a month and then following this initial period the group will meet once per month. You’ll be meeting for about 90 minutes along with a number of other patients who all have the same doctor. Just like a regular visit, you will check-in, and have your blood pressure and weight checked along with other appropriate health exams. Then the doctor goes around the room and speaks to each person about how they are doing, test results, medications, problems, concerns, and the plan of care. Some types of exams might also be done as a group at this time. Then for about a half-hour, a wellness educator or guest speaker will present an education topic. The last 5 to 10 minutes is spent with questions and answers and the group planning for the next visit. This ensures that covered topics are those that most interest our patients.

21. Does the wellness group visit replace my regular doctor appointment? For most patients, the wellness group visit will replace routine office visits. This can occur since your physician or a medical assistant will have time to check your vital medical information in a group setting, while also providing you with additional “group time” for health education and sharing.

22. How is a wellness group visit different from a regular doctor's appointment?  The group visit allows patients to share experiences about their health condition with others who may have the same problems or concerns. In this way, patients can learn from one another and find better ways to care for themselves.  Because information is being shared, patient confidentiality will be discussed, and you will be asked to sign a statement to make sure that you understand that any information talked about during the visit will not be shared outside of the group. The group setting also allows time for discussing many things that you may not have time for in a traditional doctor's appointment.  As usual, your physician, nurse, and medical assistant work as a team, making sure that your healthcare needs are met.

23. What are the benefits of a wellness group visit? With a group visit, you are able to spend additional time with your doctor and others with experience in helping patients to better self-manage their health. Although the doctor is also speaking to a number of other patients, you will be able to learn from others who have the conditions, face similar problems, and have come up with solutions that may be helpful to you. In addition, you will be able to help in the selection of topics for education that are most important to you—for example, if you have questions with meal planning, the group may schedule a Registered Dietitian to come and talk about nutrition. Many patients also find support and strength in the group setting, knowing that they are not alone. In long-standing groups, patients have often developed lasting friendships.

24. How often does the group meet? The group generally meets once per week for the first month to get acquainted. Following this, the group will usually meet monthly. With many health conditions regular follow-up with your doctor is important to maintain good health. If for any reason you prefer to see your doctor for one-on-one visits, you may do so at any time. Will my insurance pay for a wellness group visit? Your office visit benefit will determine if the wellness group visit is covered. The group visit appointment is the same billing-wise as a regularly scheduled check-up appointment with your physician. There are no extra charges for the group time spent with the physician. Your insurance will cover this as an office visit if you have an office visit benefit. Standard deductibles and office visit co- pays apply.

25. What if I need to see my doctor in between group visits? You may see your doctor between scheduled group visits as needed. What if I decide I don't want to be part of the group visit program anymore? Participation in the wellness group visits is totally voluntary and you may go back to your regular doctor's appointments at any time. Typically, patients are very satisfied with the group visit program and continue to actively participate. Where can I call if I have questions? If you have any additional questions, please contact TBD NAME AND TITLE, in your doctor’s office. TBD Name can be reached at TBD Phone Number, between Time and Time, Monday through Friday.

26. Conclusions

27. Resources