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The Article in Brief
Exploring Attributes of High-Value Primary Care
Arnold Milstein , and colleagues
Background To address criticisms that the US health system rewards service volume rather than value, Medicare and some private payers are defining and rewarding high value. However, little is known about what physicians can do to attain low per capita spending and favorable quality scores for Medicare and non-Medicare populations. This study set out to identify care delivery attributes associated with value as defined by payers.
What This Study Found Six attributes of primary care delivery are associated with high value: 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. Researchers analyzed commercial health insurance claims data from 2009 to 2011 for more than 40 million PPO patients and 53,000 primary care practice sites and found that the six statistically significant attributes relate to three themes: the need for "care traffic control" to help patients with complex conditions navigate the fragmented US health care system (risk-stratified care management, careful selection of specialists, and coordination of care), the need for tools to ease the cognitive burden of physicians and staff (decision support for evidence-based medicine and standing orders and protocols), and the importance of reimbursement based on value rather than volume (balanced compensation).
Implications
- According to the authors, awareness of care delivery attributes associated with high value may help physicians respond successfully to incentives from Medicare and private payers intended to lower health care spending and improve quality of care.
Supplemental Appendixes
Supplemental Appendixes
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- Supplemental data: Appendixes - PDF file