“I believe we’re starting to see the pendulum swing back the other way,” James Gutierrez, MD, chairman of Cleveland Clinic’s Primary Care Institute, told Becker’s. “We’re re-evaluating the positive value of annual physical exams, particularly for certain populations.”
These populations include older adults who are over 65 and those with chronic diseases. Older adults have benefited from Medicare’s annual wellness exam, which includes a senior health risks screening that helps with early risk detection in blood pressure, fall risk, cognitive impairment and more.
“By proactively identifying these risks, we can intervene before a crisis happens — for example, helping a patient prevent a fall and fracture or addressing early memory loss before it progresses,” Dr. Gutierrez said.
However, a one-size-fits-all approach doesn’t work for every patient, so systems are working to restructure their visits to match the needs of the patients.
Cleveland Clinic only has healthy patients come in for visits when they are due for screenings, vaccinations, blood pressure monitoring or preventive counseling.
Norfolk, Va.-based Sentara Health is working with a startup company to create an AI clinical decision support tool that will integrate evidence-based guidelines to personalize provider recommendations at the point of care.
“We need to recognize that physician and APP time is a finite resource — it has to be managed and budgeted to ensure we’re using it at its highest value,” Steve Pearman, chief medical officer of primary care at Sentara Health, told Becker’s. “This allows for a patient-centered discussion on what’s actually needed rather than a generic checklist.”
Sentara also uses a risk-stratification system based on social determinants of health, clinical complexity and overall patient needs to create recommendations for preventive care. This allows the system to better allocate provider time so the higher-risk, complex patients are prioritized for direct care, while lower-risk patients can be cared for by the extended team. So far, 18 primary care sites at Sentara have transitioned to the redesigned care model.
“The goal is to free up providers’ time for the most valuable work — preventing ER visits, reducing hospitalizations, closing care gaps and optimizing chronic disease management,” Dr. Pearman said.
Durham, N.C.-based Duke Primary Care is “thinking creatively” about how to optimize visits for non-Medicare patients, Kevin Shah, MD, vice president of Duke University Health System and chief medical officer of Duke Primary Care, told Becker’s. This includes having more screenings filled out by patients on tablets before they see a provider. They are also using automated reminders and flags in the EHR to automatically generate reminders based on patient demographics. These reminders are managed by nurses who tee up orders for physician review and signature.
But despite changes to annual visit recommendations and flow, Dr. Gutierrez said the system is doing more annual exams than 25 years ago. Two reasons that account for the increase are the relatively new Medicare Annual Wellness Exam and more patients are aging or have more chronic conditions.
“Those two factors alone mean that more of our patient population benefits from annual exams than before,” he said.
Across the board, leaders agree that wellness visits are important, “but only for the right population, at the right time, and managed by the right team,” Dr. Pearman said. “They shouldn’t require a 30-45 minute physician visit when much of the work can be done by a care team ahead of time.”
How visit changes impact operations
Changing the structure of annual visits have had a few positive impacts on physicians, patients and operations.
For physicians, many providers are working the same hours and feel less burned out. Why?
“They’re doing more meaningful clinical work instead of admin work,” Dr. Pearman said. “Their time is spent on patient care, not clerical tasks.”
Physicians are also working more efficiently, Dr. Shah said, and nurses are able to work at the top of their license which helps streamline workflows.
Technology has been a large part of efficiency work with great results for physicians and patients.
“By automating outreach and using EHR-driven reminders, we minimize care gaps without requiring extra provider visits,” Dr. Gutierrez.
Patients are seeing improvements in a number of ways.
For patients at Cleveland Clinic, the changes have improved cancer screenings and vaccination rates.
Over at Duke, patient engagement has improved as patients appreciate the thoroughness of the visits and feel they are receiving holistic care, Dr. Shah said.
At Sentara, shifting low-acuity care to extended teams has freed up physicians for more complex cases.
“This approach also gives us a competitive edge over retail disruptors and urgent care models,” Dr. Pearman said. “Instead of saying, ‘This is too complex. Go find someone else,’ we guide patients to the right next step within our system. That’s a huge differentiator.”
The beginning of a movement
Leaders said this is only the beginning of the journey.
“For years, research downplayed the value of routine physicals,” Dr. Gutierrez said. “But today, I realize that fewer and fewer patients are truly ‘routine.’ More patients have chronic conditions, and the need for preventive care has never been greater. The key is targeting the right patients and optimizing visit structure so we can maximize impact — both for patients and for the healthcare system.”
And for systems, the focus isn’t just about making changes that improve experiences for patients.
“Healthcare systems focus on patients — which is great,” Dr. Pearman said. “But providers and staff are also consumers. If we don’t address their needs, we won’t have a sustainable system. That’s why I’m focused on care innovation and sustainable models. We need a future-proof primary care system that prevents burnout, uses AI and technology wisely, and leverages care teams to maximize impact. That’s the path forward.”
