2023 Acclaim Award Recipient

Continuing the Journey to High-Value Care

Premier Medical Associates was recognized for the following initiatives:

• Premier Medical Associates has incorporated AMGA’s High-Performing Health System™ attributes into their multispecialty practice in the following ways:
• Developing a strong focus on improving the control of chronic diseases, increasing screening rates, and improving immunization rates to reduce the incidence of preventable diseases
• Creating a patient experience committee and appointing patient experience managers
• Participating in a Clinically Integrated Network (CIN) that includes provider and hospital participants across three states
• Attaining level 3 NCQA Patient Centered Medical Home certification continuously since 2013
• Creating an equity dashboard for colorectal cancer (CRC) screening rates, hypertension control, diabetes control, and more 

This is the second time Premier Medical Associates has received the Acclaim Award. They were named the recipient of the award in 2016.

The practice formed in 1993 when several like-minded independent groups merged with a plan to become a multispecialty group that provided better care to the patients that it served.  With 106 providers, the practice has provided care for nearly 100,000 lives in its catchment area. Premier Medical Associates has been recognized locally, regionally and nationally for multiple successful population health initiatives.

As part of the application process, each group was asked to detail their project narrative. See Premier Medical Associates’ narrative below.

Improving CRC Screening

As part of the Acclaim Award application process, healthcare organizations are asked to submit narratives describing major system-wide initiatives that exemplify the goals of the award. One of the narratives from Premier Medical Associates’ application, “Quality, Efficiency and Equity: Accelerating the Value Journey,” is summarized below.

The American Cancer Society predicted more than 150,000 new cases of colorectal cancer (CRC) in the U.S. in 2022, with more than 52,000 Americans dying from the disease.

Premier Medical Associates (PMA), recognizing that a large number of deaths related to CRC could be prevented with effective screening, increased its overall screening rate for patients ages 50 to 75 from 57.5% in January 2013 to above 80% in October 2016. Premier’s emphasis on patient-centered discussions and personal choice in screening modality allowed the practice to keep this rate greater than 80% even in 2020 and 2021, when nationwide CRC screening rates saw a decline due to the global COVID-19 pandemic.

In 2018, the American Cancer Society recommended lowering the starting age for CRC screening from 50 to 45, and the United States Preventive Services Task Force followed suit in 2021. As PMA’s screening rate for the 45–49 years age range was 35%, the practice used an automated system to text and/or call 1,516 patients who were due or overdue under the new guidelines. The message read: 

“The American Cancer Society and other national organizations recommend screening for colon cancer now begin at the age of 45. There are simple, affordable options, including tests that can be done at home. You will be receiving one of these home tests in the mail shortly. Please complete and return this test as soon as possible. Please let your office know if you have any questions. Thank you.” 

One week later, Premier’s fecal immunochemical test (FIT) kit partner, Polymedco, mailed these patients a letter explaining the importance of the test, a test kit, and prepaid return envelope. Within a month, 433 of these patients returned a completed FIT (28.6% successful return rate), increasing the overall screening rate for this age group of patients to 53.6%. There were 19 positive FIT results out of the returned 433 (4.4% positive rate). Five advanced adenomas (>10mm size) were found and removed on colonoscopy exams of the 19 patients. As a result, this project likely greatly reduced the risk of these patients developing CRC.

Follow-Up Is Key

Fewer than 50% of patients nationwide with a positive FIT test have a timely follow-up. Premier began tracking follow-up completion statistics in 2013, long before the topic became a hotly debated topic in the national CRC screening spotlight. The practice put in place multiple processes to improve completion rates to some of the highest in the nation. These processes included:

• Allowing patients to complete stool-based testing at home if they agree ahead of time to consent to a colonoscopy on abnormal results
• Sending weekly lab reports to PMA’s central quality office to ensure patient’s notification of abnormal results
• Reminding all providers and staff that all patients with a positive FIT require a colonoscopy and that repeat non-invasive tests should never be ordered even if requested by the patient
• Arming medical assistants with a script to explain the rationale for follow-up testing if patients balk at scheduling a required colonoscopy and sending a task to the ordering provider to contact patients if they refuse scheduling
• Giving gastroenterology department schedules a list of patients with positive FIT results who require a timely colonoscopy for schedule prioritization
• Sending a personalized letter to patients who fail to schedule a colonoscopy within one moth of notification to explain the importance of completing the screening

These combined efforts led to impressive results between 2012 and the end of 2019, when 1,447 of 1,632 patients with positive FITs eventually completed a colonoscopy for a completion rate of 88.7%.

Patient pandemic-related fears and staffing shortages negatively affected Premier’s excellent record in 2020 and 2021, dropping the colonoscopy completion rate to 55.5%. Despite this drop, continued outreach regarding the importance of screening completion eventually led to 72 of 136 hesitant patients undergoing colonoscopies—a completion rate of 79%.

Addressing Health Inequities

PMA took further efforts to address and overcome sources of health inequities, in line with vigorous national dialogues about disparities that gained traction in the summer of 2020. Premier’s leadership calculated a 9% disparity in screening rates between White (82%) and Black (73%) patients for the practice year ending June 30, 2021.

In addition to the large-scale mailer that FIT partner Polymedco sent to patients overdue for screening, PMA paid an additional fee for patient navigation services that included outreach calls to Black patients at one and three weeks after mailer delivery. The script was taken from the most motivating message from the market-tested NCCRT Messaging Guidebook for Black and African American People and reads:

“Did you know that colorectal cancer is the third-leading cause of cancer death in both Black men and women in the United States? Colorectal cancer can be caught early or even prevented through regular screening. Most people should begin screening at age 45.”

This effort was so successful that by December 31, 2021, the racial disparity between White and Black patients narrowed to just 2% (83% and 81%, respectively).

In addition to addressing health disparities, the effort meets the goals of the Quadruple Aim. Its design reduces caregiver burden by leveraging team-based care, contracting for additional outreach, and using automated technology to enhance screen rates. Patient satisfaction is assured by offering patients choice in screening modalities. The effort improves the health of a population by decreasing the risk that patients will suffer from late-stage CRC, and lower costs of care result from the prevention of more costly and devastating disease.