America's Most Valuable Care: Primary Care Snapshots
There are “bright spots” in the healthcare system—healthcare providers in communities large and small who are consistently delivering better value: high-quality care at a lower-than-average total cost. In early 2013, the Peterson Center on Healthcare, established by the Peter G. Peterson Foundation, and Stanford University’s Clinical Excellence Research Center (CERC) set out to find these high-value providers through a systematic analysis of commercial insurance data that had never been done before. Through this approach, 11 primary care practices were identified as “positive outliers” for the value—higher quality at significantly lower cost—of the care they provide.
The CERC team first looked at single- and multi-specialty U.S. physician practices with at least two clinicians providing primary care. They narrowed the list to those whose performance on quality measures landed them in the top 25 percent. These quality measures were predominantly sourced from HEDIS (Health Effectiveness Data and Information Set)—a universally recognized set used by more than 90 percent of U.S. health plans for assessing quality. Researchers then eliminated all sites where total annual per capita health spending by commercial health insurers did not also fall into the lowest 25 percent—after adjustments to reflect the severity of illness of their patients.
Fewer than five percent of the roughly 15,000 sites assessed by the CERC team ranked in both the top quartile on quality and the bottom quartile on costs. Of these, the CERC team conducted a series of in-depth site visits to a sample of the highest performing sites and a sample from sites near the center on cost and quality. An expert clinical panel, blinded to the cost and quality claims data analysis, selected the following sites as providers of Most Valuable Care: