America’s Most Valuable Care: Discovering High-Value Primary Care Providers

June 16, 2017   |  Tags: Blog   |  Tags: Team Based Care , Patient Engagement , Patient Experience , Care Coordination , Best Practices
Tara DeBach

When I was asked to write a blog about America’s Most Valuable Care (AMVC) research initiative, underlining AMVC’s aim to identify healthcare system “bright spots” -- healthcare providers in communities delivering high-quality care at a lower-than-average total cost -- it seemed like a no-brainer assignment.

Yet, in the context of a fragmented health system and its convoluted incentive structure, in combination with the mass of healthcare programs, often with conflicting agendas, it’s easy to understand how a project as innovative as AMVC might become yet another acronym in a sea of healthcare minutiae. With that reality health check in mind, here’s my case for what I consider to be one of the most valuable and practical roadmaps to transforming American health care into a high-performing system that provides high-quality care.

The Team:

Stanford University’s Clinical Excellence Research Center (CERC), with support from the Peterson Center on Healthcare, set out to identify common attributes found among high-performing primary care organizations.

The Agenda:

  • Identify primary care organizations that are delivering high quality care at a significantly lower cost
  • Determine common features that set these primary care organizations apart from the rest of their peers
  • Create a “transformation map” that enables other primary care physicians to incorporate insights from high-value providers into their own practice to accelerate adoption on a large-scale.

The Outcome:

CERC reviewed national quality and cost data, and identified 11 primary care organizations that are delivering exceptional value to their patients. Most importantly, they have key features in common, which can serve as a blueprint for others to achieve high performance.

“We found that high-quality care is being provided at lower total annual cost at a small number of primary care practices. Many of these providers were largely unaware that they’re unique, but they are actually doing something extraordinary, and they have a number of features in common that can be replicated.” Arnie Milstein, Director, Clinical Excellence Research Center, Stanford University

While there was much diversity among the high-performing sites, they identified three key themes inherent to all, notably:

1.They establish deeper patient relationships: High-value organizations expand access to care for their patients, engage them in shared decision-making to reduce inappropriate use of care and services, and view complaints to be just as important as compliments, if not more, when it comes time to making practice-level improvements.

2.They develop wider interactions with the healthcare system: High-value organizations promote responsible insourcing, by enabling physicians to carry out interventions most practices would typically refer out, and only invest in equipment or supplies that would enable them to do more within the practice setting. When services outside the scope of the primary care practice are necessary, primary care clinicians rely on a carefully selected list of specialists whom they trust to follow evidence-based guidelines and remain in close contact as treatment plans develop. Lastly, care teams monitor patients outside of primary care visits.

3. They promote effective team-based care: Physicians are supported by a team of nurse practitioners, PAs/MAs, and nurses, working at the ‘top of their licenses.’  The use of standardized protocols and order sets enables broader care team members to be more autonomous in their roles. These teams also tend to work in shared work spaces to promote ongoing communication and collaboration. Lastly, physicians working in these organizations are not paid solely on the basis of their productivity.

What’s Next? The Practice Transformation Group

Our CERC team has partnered with the Network for Regional Healthcare Improvement (NRHI) to launch an exciting community of practice exclusively focused on supporting health leaders in achieving primary care transformation: The Practice Transformation Group (PTG).  

Under the HealthDoers umbrella, the PTG aims to be a home-base for learning about primary care best practices, engaging with peers, accessing valuable resources and tools, and sharing experiences and expertise. Yet the PTG will only be successful with members to help it grow, spread the word that it exists, and join the team.

For more details on the AMVC ‘bright spots’ research or on the NRHI PTG, please contact me directly at Tdebach@Stanford.edu  

Additional Resources:

Tara DeBach joined Stanford’s primary care team this past January as a Community Liaison to help lead the ongoing work with the Network for Regional Healthcare Improvement (NRHI). As part of her role, she is helping to develop a virtual community of practice focused on disseminating our AMVC primary care research findings. Prior to joining CERC, Tara worked at McKesson as a Marketing and Communications Strategist where she implemented a communications strategy, created digital and traditional marketing content, and developed digital assets content across platforms. In her personal time, she enjoys film, travel and vacationing with her family.