Six Ways to Tell if Primary Care Offers High Value

High-value care can help you pursue better outcomes for employees while reducing the total cost of care. So how do you tell if primary care is high value?

A study published in the Annals of Family Medicine in November 2017 provides insights.

Ranking Primary Care

In the study, researchers from Stanford Medicine’s Clinical Excellence Research Center looked at commercial health insurance claims data for more than 50 million patients from 2009 to 2011. The patients were part of a preferred provider organization (PPO), with care delivered at more than 53,000 primary care practice locations.

First, researchers ranked sites based on both quality and low total annual per capita health care spending.

Next, researchers selected 64 sites that were rated as high-value, as well as 102 sites that were rated as average-value. Only sites with more than one primary care physician were included.

Physicians then visited 12 high-value sites and four average-value sites to figure out what made the difference. Specifically, the study said they were seeking “tangible attributes of care delivery that could plausibly explain a high ranking on value.”

What Mattered

 Six attributes of care delivery were statistically significant for “high-value” care.

1. Decision support for evidence-based medicine
2. Risk-stratified care management
3. Careful selection of specialists
4. Coordination of care
5. Standing orders and protocols
6. Balanced physician compensation that takes into account the quality and affordability of care.

 Study author Arnold Milstein, director of Stanford’s Center, said “care-traffic control” was a common theme.

He said physicians at high-value sites were thinking deeply about what each patient must do for their health between primary care office visits, such as following through on laboratory tests and taking medicine as prescribed.

Other Differences

 Patients also have a different experience at high-value sites. According to a Fierce Healthcare article about the study, high-value sites:

• Welcome complaints.
• Offer same-day appointments and expanded hours.
• Are located in modest office space.

The Alliance is exploring the differences that lead to high-value primary care to learn more about the potential impact on employers and their employees.

We’ll continue to share what we learn along the way.

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Kathryn Otto-McLeod

Director of Member Services & Innovation at The Alliance

Kathryn Otto McLeod, director of member services and innovation, leads the team that works directly with Alliance members to understand their needs and to ensure that The Alliance evolves to respond to changing needs. She joined The Alliance in 2014 to develop new value for Alliance members through products and vendor partnerships.

Before joining The Alliance, Kathryn held leadership positions in sales, account management and product development at a variety of regional health plans, including WEA Trust, Dean Health Insurance and Physicians Plus Insurance Corp. She also applied her skills to economic development as the director of health care initiatives at THRIVE, a regional economic development organization.

Kathryn has an executive master of business administration degree from University of Wisconsin-Madison and a bachelor’s degree in business administration from Cardinal Stritch University. She holds licenses in health and life insurance.


Read more posts by Kathryn.

Latest posts by Kathryn Otto-McLeod

• Six Ways to Tell if Primary Care Offers High Value - August 21, 2018
• Nine Self-Funding Pitfalls to Avoid - July 24, 2018
• The Simple Way to Start Self-Funding - July 24, 2017