Abstract
PURPOSE Medicare’s merit-based incentive payment system and narrowing of physician networks by health insurers will stoke clinicians’ and policy makers’ interest in care delivery attributes associated with value as defined by payers.
METHODS To help define these attributes, we analyzed 2009 to 2011 commercial health insurance claims data for more than 40 million preferred provider organization patients attributed to over 53,000 primary care practice sites. We identified sites ranking favorably on both quality and low total annual per capita health care spending (“high-value”) and sites ranking near the median (“average-value”). Sites were selected for qualitative assessment from 64 high-value sites and 102 average-value sites with more than 1 primary care physician who delivered adult primary care and provided services to enough enrollees to permit meaningful spending and quality ranking. Purposeful sampling ensured regional diversity. Physicians experienced in primary care assessment and blinded to site rankings visited 12 high-value sites and 4 average-value sites to identify tangible attributes of care delivery that could plausibly explain a high ranking on value.
RESULTS Thirteen attributes of care delivery distinguished sites in the high-value cohort. Six attributes attained statistical significance: decision support for evidence-based medicine, risk-stratified care management, careful selection of specialists, coordination of care, standing orders and protocols, and balanced physician compensation.
CONCLUSIONS Awareness of care delivery attributes that distinguish their high-value peers may help physicians respond successfully to incentives from Medicare and private payers to lower annual health care spending and improve quality of care.
- primary health care
- patient care team
- health care costs
- patient-centered care
- guideline adherence
- chronic disease
- referral and consultation
- decision making
- specialization
- standing orders
Footnotes
Conflicts of interest: authors report none.
Funding support: This study and manuscript were made possible by a grant from the Peterson Center on Healthcare. The statements made and views expressed are solely the responsibility of the authors. The funding source played no role in design and conduct of the study, collection, management, analysis, and interpretation of the data, preparation, review, or approval of the manuscript and decision to submit the manuscript for publication.
Previous presentation: Before the completion of the analysis portrayed in this manuscript, an early, high-level summary of findings was presented at an event hosted by the Peterson Center on Healthcare in Washington, DC in December 2014. The content presented, which was equivalent to abstract-level findings, can be found on their website at http://petersonhealthcare.org/identification-uncovering-americas-most-valuable-care.
Author Contributions: Conception and research design: A.M., M.S., T.W.; Acquisition of data: J.F., J.M., L.P., M.S., T.W.; Analysis and interpretation of data: A.M., J.F., L.P, T.W., J.M, M.S., N.K.C, D.M.; Drafting of the manuscript: D.M., M.S., T.W., A.M.; Critical revision of the manuscript for important intellectual content: - all authors; Final approval of the manuscript: - all authors; Obtaining of funding: A.M., M.S.; Administrative, technical, or material support: T.W., J.M., M.S.
Supplemental Materials: Available at http://www.AnnFamMed.org/content/15/6/529/suppl/DC1/.
- Received for publication March 5, 2017.
- Revision received July 21, 2017.
- Accepted for publication August 22, 2017.
- © 2017 Annals of Family Medicine, Inc.