Preventive measures can lead to significant health improvements. In this episode of Meaningful Medicine, learn more about the importance of screenings and early interventions from Dr. Jeffrey Warhaftig.
Dr. Warhaftig is medical director of the Physician Quality Partners Accountable Care Organization, which ranked first in the nation for high quality performance in 2024 in the CMS Medicare Shared Savings Program.
Joey Wahler (Host): It's an efficient means of medical attention. So we're discussing preventative care. Our guest is Dr. Jeffrey Warhaftig. He's an internist and medical director for Physician Quality Partners ACO for Novant Health. They've received national recognition. More on that in a moment. This is Meaningful Medicine, a Novant Health podcast, bringing you access to leading doctors who answer questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to navigate medical decisions and build a healthier future. Thanks for joining us. I'm Joey Wahler. Hi there, doctor. Welcome.
Jeffrey Warhaftig, MD: Hello there. How are you doing today?
Host: Great. Appreciate the time. So first, why would you say, or how would you say you were first drawn to internal medicine and primary care?
Jeffrey Warhaftig, MD: To be honest with you, I, it kind of happened by accident as all the good things in life do. I was in the Army and paying off my loans for medical school and I was told by the Army as I wanted to do a cardiology fellowship that I had to go to payback time to the service first, and they gave me the choice of going to Fort Bragg or Korea. So I ended up being a primary care physician at Fort Bragg. I was there for four years as part of the required assignment for the military. And I just absolutely loved being a primary care physician. I loved being part of the lives of my patients and part of just helping them through their healthcare journey and really just couldn't imagine going back to just treating one disease all the time. And so I stuck with internal medicine and primary care and have never regretted that decision a day in my life.
Host: Wow, how interesting. And so kind of an offshoot of necessity being the mother of invention there, right?
Jeffrey Warhaftig, MD: Correct. Yes. Yes.
Host: That's great. So many are of course, familiar with an annual doctor's visit, blood work, other evaluations occur. Can you describe for us though, a Medicare annual wellness visit?
Jeffrey Warhaftig, MD: Yes, this is something Medicare started probably about seven or eight years ago. And we are very intentional to make sure that all of our patients come in for their annual wellness visit every year. And really, in addition to what we've always done, which is checking their labs and cholesterol and blood work and looking for diabetes and things like that, and checking blood pressure and, other medical problems, we have added in a bunch of additional testing that Medicare has asked us to do, which in the beginning we did it because they told us to, but we found a lot of benefit from it over the years. So we've continued to do it and have really excelled at doing this. And that is doing falls risk screening, depression screening, doing a cognitive assessment which includes the patients remembering three words and drawing a clock of a specific time. So screening patients for dementia and Alzheimer's.
We screen them for making sure there's safety within the home, that they're able to perform all their activities of daily living. We screen them for intimate partner violence, high risk sexual behavior screening. We also screen them for alcohol misuse, which unfortunately is very common in the older population.
We make sure that their advanced directives are all up to date and that they have a living will and healthcare power of attorney. If they do not have that, we make sure we give them the paperwork to get that completed and have that in their chart so that if they show up in the emergency room, we have their wishes there at the time. We make sure all their vaccines are up to date, including flu shots, COVID shots, RSV, shingle shots, et cetera. And then we also do screening for any social determinants of health that are affecting their care, looking for any strains with food, transportation, financial strains, et cetera.
So that's all something that's included in the annual wellness visit that we do every year on our patients on Medicare.
Host: So obviously that covers all the bases it would seem. Really goes well beyond what we think of as a, a routine checkup, right?
Jeffrey Warhaftig, MD: Correct. Correct. Yes. And in addition to that, we also do taking care of all their chronic medical problems, making sure they're up to date on everything there and any new issues. Most patients do come in and we encourage this, most patients come in with a list of medical questions, problems, worries, concerns that we go through at that appointment as well.
Host: Always good to have it written down or these days kept on your phone because you don't want to forget something, right? As soon as you leave the office.
Jeffrey Warhaftig, MD: Correct. Yeah. We certainly encourage the list and have no problem with that.
Host: Absolutely. So more than 60 Novant health clinics in the Wilmington area now participate in Physician Quality Partners, an accountable care organization, or ACO. For those unfamiliar, what's the purpose of an ACO?
Jeffrey Warhaftig, MD: So this is something we joined about nine or 10 years ago. We joined into this physician Quality Partners, ACO, and basically it is -- Medicare's trying to find alternative payment models on how to compensate physicians for their care that they give to the beneficiaries of Medicare. And the ACO and Medicare, specifically, the Medicare Shared Savings Program, which we participate in, is a way to try to reimburse providers for the quality of work that they do, not just the quantity of work that they do. And so Medicare has tied a lot of our cost of living increases that we get for our payment from Medicare to participating in an accountable care organization.
And specifically what they do is, is they calculate based on the sickness or illness of your patients and the diagnoses that your patients have and expected cost of care. And then what they do is, is they take our actual costs that we had to the system and if there's a difference between the two, Medicare shares with the providers some of the difference in that cost or the savings that are occurred, in the Medicare Shared Saving Program. Now, one of the things they do in that is they include in there a quality score, and they do that because they want to make sure that we're not sacrificing the quality of the care of our patients in order just to save money.
And really what we have done as a system, and we have decided to do as an ACO, is really to focus on the quality side of things. And we feel like if we treat our patients with the optimal quality care, screening them for diseases, picking up cancers early, picking up diseases early, and doing preventative medications as needed, that in turn, it will lower our overall cost, and we've been very successful with that approach.
Host: I alluded to this at the top of our conversation, Physician Quality Partners has ranked first in the nation for high quality performance for two straight years, both in 2023 and 24. First, congratulations on that. And so what types of preventative measures determine such a quality score?
Jeffrey Warhaftig, MD: So there's a total of about eight things that go into the quality score for the Medicare Shared Savings Program. Some of them I touched upon are items that we do in the annual wellness visit. So, and that's really how we've been able to get a lot of this information from the patients that we need to get.
The first one is falls risk screening. The next one is flu vaccination rates. And then after that is tobacco counseling and cessation for all the patients that are still smokers, or vaping for that matter as well, which is included in the tobacco measure. Depression screening, again, we screen all of our patients every year for depression, and that's included in the program. Colorectal cancer screening is a big one. And we've been able to actually get 88, we had 88.3% was our score in that. So that means that 88% of our patients in the Medicare Shared Savings Program were up to date on their colonoscopies or colorectal cancer screening. And that's an example of one that we really work hard because we feel like we can really save bad outcomes for our patients by being ahead of this and finding things early. So we actually, in addition to just at the appointments and making sure we get our patients up to date when they're in, we also have a campaign that we do on Saturday mornings. We have some of our staff come in, work overtime and contact patients who are overdue for their colonoscopies or colon cancer screening and offer them to do stool cards or the Cologuard, which is the mail-in sample that gives you a three year screening for colon cancer or we if needed, or they need to get a colonoscopy and that's the most appropriate route for them, they'll set them up for an appointment for a colonoscopy before the end of the year. So that's one we work pretty hard. In addition, breast cancer screening, we were over 90%, on mammogram screening for our patients, which is very high and again, we do the same thing on Saturday mornings. We reach out to all the women who are due for their mammography. We also do a lot of mass MyChart messaging to try to get to our goals on these things. We'll MyChart message all the patients who have delinquencies to see if they are ready to schedule and then we can reach out to them and set them up for their appointment.
The next metric is actually diabetes control and it's the number of patients that have their A1C's below goal and to get them, get their A1Cs below nine is the metric for Medicare, and that one we work out really hard as well because we want to get our patients under control with their diabetes. We did excellent on that as well. And on that one, what we do is, is we set the patients up. If there's one of the biggest barriers to getting people under control for diabetes is the cost. The cost of medications have gone outrageous in the last five, six years for diabetic control, especially the GLP-1 inhibitors, which are Ozempic and Mounjaro. And what we've done is, we partner with our pharmacy team at the hospital to try to get these medications for them at the lowest possible cost. So we make referrals for all of our patients that have A1Cs over nine to the pharmacy team to have them get more intensive work with the pharmacist and try to see if we can help them with cost on their drugs.
In addition, hypertension control is another metric that we follow, and that's really just following up with our patients and getting their blood pressures to goal. And then on top of all this, there is a patient satisfaction survey that gets sent out to all the patients on Medicare. And again, it's making sure that we're doing this in a manner that the patients are satisfied and happy with. And we also did excellent on our patient satisfaction survey that was sent out.
Host: And certainly among the things you mentioned, breast cancer screenings, colon screenings. Two great examples of things that, can go a long way, can really make such a difference.
Jeffrey Warhaftig, MD: That's correct. And really, and when you look at, again, the total cost of care, it's a lot less cost of care to treat somebody if you find them as a stage one early breast cancer and you just have to send them for a lumpectomy only, and that's all they need. As opposed to someone who comes in because they have a palpable mass and they have symptoms, and if they find it with symptoms, then it's much more likely to be advanced stage disease, which requires high-cost chemotherapy, radiation, and other treatments like that. And so that really increases the cost of care. So, that's how we've been successful on the cost side is all on preventative screening and finding disease early. If you can imagine a colonoscopy with removal via colonoscopy is a lot less than something gets so big that you have to do surgery, et cetera. Plus the lives saved is enormous on top of that.
Host: Absolutely. Now, a couple other things for you. That recognition we discussed, it focuses on Medicare patients, but are you also using these same approaches with preventative care for all the patients served by your clinics?
Jeffrey Warhaftig, MD: Yes, we are. And we treat them all the same. And in fact, the Medicare for 2025 program year has actually gone to an all-payers approach. So we actually have to give them our data from all of our payers in this coming year, but we've always done that. So it doesn't, bother us that that's the new approach -- the only thing that's different is, is they don't have the specific annual wellness visit that we discussed with the other screening items. But as far as we call it care gaps, which are all the gaps in care in screening, we review care gaps at every visit with every patient to make sure that they've had their vaccinations, their colon cancer - their screenings, that they should have, their PSAs for men over the age of 45, et cetera. So we do that on a regular basis on all of our patients.
Host: Gotcha. Good to know. And then in summary, doctor, based on your years of experience, do you envision similar efforts catching on as a best practice for more clinics to model throughout the country as well.
Jeffrey Warhaftig, MD: Yes, and I've gotta say that I give a lot of our success to our engagement that we've gotten from our patients, and part of the reason we have been able to be so successful really is because our patients do the screenings right? In the end, I can only recommend it, right? I can make the referral, I can call them and remind them to make the referral, but at the end of the day, they have to go for the colonoscopy.
They have to go through the discomfort of a mammogram. And so we're very fortunate to have a nice patient population here that has been, that accepts our recommendations, follows through with our recommendations, and for that we are very grateful.
Host: It definitely takes two to tango where all of that is concerned. Well folks we trust you are now more familiar with preventative care. Doctor pleasure. Keep up all your great work and thanks so much again.
Jeffrey Warhaftig, MD: Thank you. Appreciate that.
Host: Same here. And for more information, please do visit novanthealth.org/healthy-headlines. If you found this podcast helpful, please share it on your social media. I'm Joey Wahler, and thanks again for being part of Meaningful Medicine, a Novant Health Podcast.
