Table 3

Attributes More Frequently in High-Value Practices Relative to Average-Value Practicesa

Expanded accessPractices offer same-day appointments and accommodate walk-ins, extend evening and weekend hours, and often take their own after-hours calls with access to their patients’ electronic medical records.
Decision support for evidence-based medicineaThe care team ensures that patients receive all evidence-based care and treatment, often by making guideline-based reminders available to clinicians in the electronic medical record. Some practice office managers regularly run reports to identify care gaps to alert the care team to take action—such as a list of patients overdue for colorectal cancer screening. Physicians consciously avoid ordering tests that would not change management.
Risk-stratified care managementaEach patient receives support that is matched to his or her unique needs. High-risk patients are monitored and advised by a care manager, scheduled for longer office visits, receive frequent phone checks by office staff, or in some cases, clinician home visits.
Shared decision-making and advanced care planningWhen diagnostic and treatment options substantially differ in their consequences and cost such as care near the end of life, clinicians walk patients through likely scenarios and tradeoffs.
Complaints are goldComplaints from patients are perceived to be as valuable as compliments, if not more so. Practices take every opportunity to encourage patient feedback.
Comprehensive primary careClinicians practice within the full scope of their expertise, including services that primary care clinicians often refer out, such as skin biopsies, suturing, insulin initiation and stabilization, joint injections, and IUD placement. In some cases, such as treadmill testing, practices arrange training and supervision by specialists.
Careful selection of specialistsaWhen services outside the scope of the primary care practice are necessary, primary care clinicians rely on a carefully selected list of specialists with whom they trust to follow evidence-based guidelines and remain in close contact as treatment plans develop.
Coordinated careaCare teams monitor patients outside of primary care visits. They ensure patients complete referrals to specialists and schedule timely follow-up after unexpected hospitalizations. In some cases, they track medication adherence by communicating with pharmacies or counting refills.
Upshifted staff rolesPhysicians are supported by a team of medical assistants, front desk staff, and in some cases, nurses and advanced practice clinicians who practice near the full potential of their education, skills, and licensure. As a result, physicians devote more time to the most complex patients.
Standing orders and protocolsaPractices develop standing orders and protocols for uncomplicated acute illnesses and chronic disease management. Nonclinician team members use these standardized workflows to care for patients without requiring direct clinician intervention.
Shared work spacesCare teams including clinicians and nonclinicians work together in a common work area, enabling face-to-face communication that facilitates problem-solving in real-time.
Balanced compensationaPhysician salary is linked to value instead of only volume. Compensation reflects performance on at least one of the following components: (1) quality of care, (2) patient experience, (3) resource utilization, and (4) contribution to practice-wide improvement activities.
Low overhead space and equipmentPractices rent modest offices and typically invest in laboratory, imaging, and other equipment only if it allows clinicians to provide care more efficiently than referring to outside services. Some practices partner with other practices to jointly operate imaging equipment at a lower cost per study.
  • IUD=intrauterine device.

  • a Attributes with a statistically significant association with high-value practices compared with average-value practices.