Six attributes of primary care delivery are associated with high value, according to a new study: 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. The findings are the result of a mixed methods study of diverse primary care practices that are well positioned for the shift toward medical reimbursement based on quality and efficient resource use rather than volume. Thus, researchers sought to identify care delivery attributes associated with value as defined by payers. They analyzed commercial health insurance claims data from 2009 to 2011 for more than 40 million PPO patients and 53,000 primary care practice sites, excluding sites operated by large national health care organizations subject to population-based payment. 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). 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.
Exploring Attributes of High-Value Primary Care
Arnold Milstein, MD, MPH, et al
Stanford University, Stanford, CA