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Stanford University School of Medicine

Identifying ‘high-value’ practices in primary care; a Stanford study pinpoints key attributes

What makes a physician's practice great? The ability to deliver high-quality health care at the most affordable cost is one key component that benefits patients, physicians and insurers alike. This kind of 'high-value' care is so important that it's been designated a national priority as a way to reduce skyrocketing health care costs; in 2019 physicians' payments from Medicare will be adjusted up or down to reflect how that doctor meets national benchmarks for high-value care.

But until now, no one has identified specific changes that individual doctors or care organizations can make to meet these goals. That is, until Stanford's Arnold Milstein, MD, headed a study of primary care delivery using never-before-available commercial health insurance claims from 2009 to 2011 from more than 40 million patients and 53,000 primary care practice sites across the country.

Milstein is the director of Stanford’s Clinical Excellence Research Center, the first university-based research center exclusively dedicated to discovering, testing and evaluating cost-saving innovations in clinically excellent care.

Milstein and his colleagues used the data to identify physician-practice sites across the country that deliver high-quality care with a lower overall cost. They then conducted extensive site visits to determine what these practices were doing differently than average-value practices (these also delivered high-quality care). They published their results in the Annals of Family Medicine.

As Milstein explained to me:

No one has ever studied this intersection of high-quality and low-cost health care at a national level for individual physician offices. We’re hopeful that these studies will help American physicians and policymakers better understand what tangible changes in care-delivery practices will allow physicians to meet our national thirst for more with less.

The researchers found some common themes, including the implementation of a concept that Milstein termed "care-traffic control."

We found that physicians at these sites were thinking more deeply about what each individual patient needs to navigate in the periods between primary care office visits... Does their illness affect their executive functioning? Are they following through on laboratory tests? Are they taking their medicines as prescribed? Are all of the doctors and specialists a patient sees aware of important aspects of their care plan, such as the existence of an advance directive? Although this is unknown territory to physicians in average-performing primary care practices, it is actively surveilled and supported by their high-value peers.

Other important themes included the use of standard treatment protocols to ease the cognitive burden on the care staff and a system to ensure that the compensation packages for physicians and care staff members reflect the quality and affordability of the care they provide. The researchers also found that high-value practices usually welcome complaints, offer same-day appointments and expanded hours and are located in "modest" office space.

As Milstein explained, “We wanted to understand what’s different about the care of the high-performing clinical teams that allows them to lower the cost of excellent care, which is an aspiration of both Congress and of private insurers. These studies are the first to distinguish attributes of physicians who provide great, more affordable care.”

Previously: A glimpse inside Stanford Coordinated Care, an innovative model of health care, How primary care physicians can embrace population health and Spotting stellar primary care practices, Stanford study identifies 10 practices that lead to excellence
Photo by RobynsWorld

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