Shared Medical Appointments: Benefits, Costs, and More

Shared medical appointments aim to solve the major issues in westernized medicine.

The 3 main problems with the healthcare system in the United States are:

1. Poor patient satisfaction
2. Rampant chronic diseases and bad health outcomes
3. High cost

Chronically lousy health in the US has been thrown into the spotlight during the COVID-19 pandemic. Americans spend more on healthcare than people of any other nation, yet we’re the 31st highest country for life expectancy. 

In addition to these problems, people in the United States are very often dissatisfied with their quality of care from their primary care providers.

Fortunately, several systematic reviews and thousands of individual studies have discovered the same thing: shared medical appointments lead to better health and quality of life, less expensive healthcare costs, and better doctor-patient relationships.

These visits may even be done virtually, now that healthcare has developed comprehensive telehealth services in light of the ongoing pandemic.

At PrimeHealth, we use group medical visits to facilitate better patient education and give our patients the benefits of community as they work to improve their health.

What is a shared medical appointment?

Shared medical appointments (SMAs) are healthcare visits in which a group of people meets together with their healthcare providers to discuss treatment and/or prevention of chronic disease. 

SMAs involve lab work and testing similar to any other medical visit while adding the benefits of a group setting. Often, these group visits are focused on broad lifestyle changes, which is why they’re beneficial for both disease management and disease prevention.

These appointments/visits may go by multiple names, including:

• Shared medical appointments (SMAs)
• Group visits
• Group medical visits (GMVs)

Group medical visits have been around since the early 1990s and are employed in both very large clinics as well as small primary care settings. They’re a combination of medical assessment, disease management, and support group.

Each healthcare provider can tailor their shared medical appointments to their patients’ needs, culture, and specific health concerns.

Group visits may be offered based on a specific condition (for instance, for patients with type 2 diabetes) or preventative lifestyle modifications, such as managing heart disease risks or preventing dementia and cognitive decline.

Ultimately, SMAs can be used for a huge number of conditions or prevention strategies. Group medical visits are currently implemented throughout the world for patients with:

• Diabetes
• High blood pressure (hypertension)
• Congestive heart failure
• Chronic lung disease
• Asthma
• Arthritis
• Chronic sinus infections
• Stroke
• Kidney disease
• Cancer
• Hearing impairment
• Chronic pain
• Prenatal care needs

SMAs can be used preventatively or as part of a comprehensive treatment program. Some group visits are designed as follow-up care after certain surgeries and other procedures.

Entrepreneur James Maskell has been advocating for the broad use of group medical visits for many years. Most recently, his 2020 book The Community Cure explains why and how these visits are so crucial for managing chronic conditions.

Well-known healthcare organizations have implemented the shared medical appointments model, such as:

• Cleveland Clinic (including the Center for Functional Medicine led by Dr. Mark Hyman)
• Harvard Vanguard Medical Association
• Yale Health
• University of Wisconsin at Madison
• Memphis VA Medical Center
• Kaiser Permanente

Can you do telehealth group medical visits outside of your home state? You may sometimes attend telehealth group visits outside of your home state. The question of how broad the practice area hasn’t been totally answered in the COVID world due to the supposedly temporary changes made to HIPAA and other medical privacy laws.

Typically, if the first visit happens in person, a healthcare provider can treat a patient remotely anywhere in the country from that time.

Benefits of Shared Medical Appointments

1. Affordability

The first and most attractive benefit of SMAs is that they are typically less expensive than individualized visits, while still providing high-quality care.

In other words, your primary care physician may be able to both maintain a higher level of quality equipment, staff, and office while you pay less per visit.

The total cost for the services you get is significantly less than what you’d pay for individual visits over time. It’s cost-efficient because the patient gets a lot more interaction with the providers and coaches for less money.

Chronic conditions are common for low-income people, particularly those in marginalized communities — in part, due to poor food quality over long periods of time. Shared medical appointments may help to make a dent in this inequity.

In a systematic review of group medical visits for overweight, obesity, or diabetes, researchers found that these visits reduced the “long-term cost of care” and the efficiency of health care practices.

2. Community

In areas of the world known for positive long-term health, known as “Blue Zones,” the number one predictor of health and all-cause mortality is social connections. This is true even accounting for a lifelong healthy diet!

At PrimeHealth, our group visit participants rave about the community built through a journey with others in similar situations.

Typically, group visits may include anywhere from 5-15 people in the room as well as the provider(s). We use a semi-structured process to facilitate a connection between the patients. This interactive approach allows patients to ask questions and share their own experiences or even “hacks” they use to manage their condition.

While we as health care providers understand many of the scientific parts of a disease process, there is a powerful benefit to learning more about the human side of what it’s like to live with a disease. Patients are both being educated and educating one another.

According to a 2017 review, some of the reasons patients benefit from this community are that:

• Being in this group combats a feeling of isolation in one’s illness
• Patients learn vicariously through their peers about the self-management of their disease
• Inspiration hits when patients see others in the group finding success
• The first-hand information from peer support, combined with the professional recommendations from providers, creates a more “robust” knowledge of how to manage a condition than a single provider could offer

3. Accountability

As an overflow from the community aspect of these medical visits, patients also find added accountability. 

Peers from the group expecting you to be there can reduce no-shows. Interaction in and outside of the group means you may have more accountability when changing your lifestyle habits.

In addition, one provider shared in a review of GMVs/SMAs that patients tend to trust the advice of another patient over professionals alone “because patients can speak directly from their experience.” This not only helps a patient stick to the plan but also strengthens the sense of accountability between patient and doctor.

4. Better Doctor-Patient Relationship

A typical visit to your primary care provider might last anywhere between 5-20 minutes, depending on your needs. A group visit, however, is usually 60-120 minutes long, which means greater and more efficient access to your provider.

A shared medical appointment means you have more time with your provider, which results in feeling more supported and “more equitable relationships”.

One reason SMAs help patients feel supported is because group visits allow providers to truly engage with the emotional and interpersonal stigmas that are often connected to chronic diseases. 

Patients are no longer pages of lab work and medication regimens; they’re people.

A study of group visits hosted by nurse practitioners found that these appointments “may disrupt inherent power differentials that exist in primary care.” In other words, the implied power of the provider over the patient may be disrupted or removed when the approach becomes a team effort.

5. Improved Health Outcomes

When you attend shared medical appointments, the overall improvements to your health may be more significant than with standard office visits.

The benefits of SMAs for clinical outcomes may happen because the locus of control is shifted onto the patient, rather than outside factors. 

It is easier to see yourself in the driver’s seat, capable of improving your own health, rather than as a victim of a disease you cannot control.

I have found that patient education and a better understanding of one’s condition or risks is another reason group visits result in better overall outcomes. The group dynamics of these appointments often leads to questions, discussions, and advice shared between patients that’s more extensive than one practitioner can provide during a private visit.

Group visits may improve coping skills, quality of life, and the ability to solve problems caused by medical conditions or disease risks beyond what patients experience in usual care.

Some of the most common uses of the SMA model are in prenatal care and diabetes management. 

In group prenatal care using the SMA model CenteringPregnancy, preterm birth rates are lower. 

Diabetes patients in SMAs led by a diabetes educator have seen reduced HbA1c levels, blood pressure, and overall cholesterol as well as better control over blood sugar levels.

6. Patient Satisfaction

Interactive group medical visits regularly have extraordinarily high patient satisfaction rates. There are many reasons patients are thrilled with their quality of care during group visits, from empowerment to practical benefits to social support.

In my personal experience working with patients in an Alzheimer’s prevention program, people who wouldn’t normally socialize with others have come alive. The stigma associated with a dementia diagnosis often causes individuals to delay seeking a diagnosis and care, and can lead to social withdrawal. The group setting of SMA’s provides a safe environment that encourages community and self-empowerment that is often the difference between stopping or reversing cognitive decline and further progression.

By avoiding isolation, leaning in to peer support, and experiencing better patient education, people in these groups are often able to make lasting lifestyle changes they didn’t think possible.

In studies of the SMA model, patients are satisfied with visits because:

• Providers have a better sense of how to meet our patients’ needs by getting to interact more with patients in a group setting
• Patients trust their providers more as they see them encourage social support and working with fellow patients
• The social support from peers makes major lifestyle changes seem more achievable
• Patients feel as if they are actually active participants in their own health
• A better understanding of cultural context helps patients feel more comfortable during their appointments

7. Provider Satisfaction

Not only do patients love the SMA model, but health care providers do, too.

Providers feel more appreciated, they get along better with their colleagues, and they see that patients trust them more during group visits.

It’s also easier for clinicians to understand the true needs of patients in daily life when they act as a facilitator to group medical visits. 

One major benefit of this relationship is that a provider can learn more about the real-life reasons patients aren’t able to stick to their plans and address those barriers. This means better patient adherence, which means better outcomes, which means a happier health care provider.

In fact, SMAs/GMVs seem to be an answer to preventing burnout among health care teams. The social benefits don’t just help patients; they can solve many issues experienced by overwhelmed providers (including social isolation). This enables the clinicians to offer more supportive care and can help the provider(s) to develop a deeper understanding of patient needs. 

Providers who offer group visits can offer comprehensive care to more patients in less time without sacrificing quality of care.

Costs & Insurance Coverage of Group Visits

The cost of a group medical visit depends on your provider’s location, pricing structure, and insurance model. Typically, a group visit will cost less than a one-on-one appointment in a cash-only practice but may cost the same in a practice that bills insurance.

Are shared medical appointments covered by insurance? Shared medical appointments may be covered by insurance, but this may differ by primary care practice or clinic. Many group visit programs follow an insurance reimbursement model. 

At PrimeHealth, we provide group visits on a monthly membership basis but do not bill insurance.

Be sure to contact your primary care provider about costs and insurance coverage ahead of time. Every practice and insurance plan is different, and your provider’s office can help you figure out the true costs you’ll be responsible to pay.

PrimeHealth Members: If you participate in a group visit program, the cost of your group visits will be deducted from your one-on-one membership if you choose to go to a one-on-one model after the group visit program.

What to Expect

How long do group medical visits last? Most group visits last between 60-90 minutes. PrimeHealth’s group programs include 90-minute visits. We want people to get better, faster, for less money!

How often do shared medical appointments occur? Shared medical appointments may occur as often as twice per week to as little as one time per month. The schedule for group visits depends entirely on your provider or clinic.

How are group visits structured? There are 2 basic structures for group visits: drop-in group medical appointments (DIGMAs) and cooperative health care clinics (CHCCs). 

At PrimeHealth, we use both the CHCCs model (where patients come at the same time and participate in the same 90-minute interval) and the DIGMAs model (where patients come and go at their convenience during a large period of time).

What should I expect at a group medical visit at PrimeHealth? 

We typically start with a greeting and review of what we’ve covered in the most recent session.

Each visit then involves a meditation or “centering” practice. This lets everyone — patients and providers — leave our stress at the door. It’s important to us to create a healing atmosphere right at the very beginning of each session. Many participants share that their stress alleviates very quickly at the start of the visit.

After meditating, we host a time for interaction within the group. We may use conversation starters, mindfulness exercises, or even movement techniques that can help reduce stress (like tai chi) that promote community. 

Afterwards, the provider gives an educational presentation about something relevant to the group (usually, lifestyle factors that enhance health and wellness related to the condition at hand).

Can I still see a provider one-on-one if I’m part of a group visit program? Yes, our blended approach allows for individual patient sessions in addition to group meetings.

At your one-on-one appointment, you can discuss how you’re doing with the group visit model, review anything you may not want to discuss with the group, and talk about specific test results.

Although each group member gets individualized lab testing, group visits allow us to cover common results. 

For instance, stool tests are common in a functional medicine practice. I can review the structure of the stool test report and explain what the findings mean to the group as a whole. Participants can choose to ask questions and interact based on their individual results, or wait until a private appointment to discuss their results..

Is a group medical visit/SMA right for me?

There’s a stigma associated with chronic illness. Group visits can help alleviate that stigma and offer patients a gold standard of care — potentially for less than they would pay for one-on-one visits.

Who are group medical visits best for? Patients with “complex medical and social needs” are best suited for shared medical visits. 

People at risk for conditions such as Alzheimer’s disease can also see a great benefit by addressing important lifestyle prevention strategies early on before the disease can take hold. The first changes that eventually lead to Alzheimer’s actually start in a patient’s early 40s, decades before signs of cognitive decline occur.

Who are group visits not best for? Group medical visits may not be right for those who aren’t comfortable in a group setting or have major social anxiety about sharing personal information. 

Some people require a lot more individualized care, especially when concerned with acute medical conditions. 

PrimeHealth offers group medical visits to patients with hypothyroidism, risk factors for Alzheimer’s disease, and other chronic health concerns. Contact us today to learn more about our group visit programs!

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