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Feb 1, 2020

The attributes of high-value primary care

For many years, the health system in the U.S. has been criticized for rewarding volume of services rather than the value of services provided. Over the last several years, primary care practices and insurance companies have worked together closely to create a new approach that works to reverse that trend as well as create a high-value primary care experience for providers and patients.

We all realize the importance of striving to provide high-value primary care. But, what exactly does that mean? What are we aiming for, and why? High-value primary care has several advantages, including:

  • Excellent and equitable health outcomes
  • Judicious use of healthcare resources
  • Reduced cost to patients, health insurance payers, and the overall healthcare system – high-value primary care can save 15-30 percent of the total cost of care in as little as 12-18 months1
  • A systematic approach to measuring, reporting, and improving health, quality, and safety
  • Exceptional experiences for patients and providers:
    • More time with caregivers
    • More ways to access care, including telephone, email, and telehealth services
    • More services available at the primary care office

An article published in the Annals of Family Medicine2 distilled 13 attributes that are more frequently found in high-value primary care practices compared to average-value practices. Of those 13, six have been shown to be statistically significant. Those six attributes and their descriptions are below (see all 13 at www.annfammed.org):

  • Decision support for evidence-based medicine – The 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. Staff run reports to identify care gaps to alert the care team to take action (e.g., a list of patients overdue for colorectal cancer screening). Physicians consciously avoid ordering tests that would not change management.
  • Risk-stratified care management – Each patient receives support that is matched to their 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.
  • Careful selection of specialists – Primary care clinicians rely on a carefully selected list of specialists they trust to follow evidence-based guidelines and remain in close contact as treatment plans develop.
  • Coordinated care – Care teams monitor patients outside of primary care visits, ensuring 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.
  • Standing orders and protocols – Practices develop standing orders and protocols for uncomplicated acute illnesses and chronic disease management. Non-clinician team members use these standardized workflows to care for patients without requiring direct clinician intervention.
  • Balanced compensation – Compensation is linked to value instead of only volume, and reflects performance on at least one of the following: quality of care, patient experience, resource utilization, and contribution to practice-wide improvement.

BCBSRI has worked with our physician partners over the last several years to build systems of care in our state which create more cohesive, rewarding healthcare experiences for our members, your patients. The study in the Annals helps us all to focus on the “right” areas to ensure we create that sought-after value. As always, we value your partnership and look forward to continuing this important work on behalf of the state’s healthcare system.

1The-Alliance.org – Employers moving health care forward

2www.annfammed.org

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