RT Journal Article
SR Electronic
T1 Measuring Physician Quality and Efficiency in an Era of Practice Transformation: PCMH as a Case Study
JF The Annals of Family Medicine
JO Ann Fam Med
FD American Academy of Family Physicians
SP 264
OP 268
DO 10.1370/afm.1784
VO 13
IS 3
A1 Lewis G. Sandy
A1 Heidi Haltson
A1 Brent A. Metfessel
A1 Conway Reese
YR 2015
UL http://www.annfammed.org/content/13/3/264.abstract
AB Practicing physicians face myriad challenges as health care undergoes considerable transformation, including advancing efforts to measure and report on physician quality and efficiency, as well as the growth of new care models such as Accountable Care Organizations and patient-centered medical homes (PCMHs). How do these transformational forces relate to one another? How should practicing physicians focus and prioritize their improvement efforts? This Special Report examines how physicians’ performance on quality and efficiency measures may interact with delivery reforms, focusing on the PCMH. We note that although the PCMH is a promising model, published evidence is mixed. Using data and experience from a large commercial insurer’s performance transparency and PCMH programs, we further report that longitudinal analysis of UnitedHealthcare’s PCMH program experience has shown favorable changes; however, cross-sectional analysis indicates that National Committee for Quality Assurance’s PCMH designation is positively associated with achieving program Quality benchmarks, but negatively associated with program Efficiency benchmarks. This example illustrates some key issues for physicians in the current environment, and we provide suggestions for physicians and other stakeholders on understanding and acting on information from physician performance measurement programs.