​Providers who deliver high-quality, low-cost care often possess one or more of six attributes, according to a study published in the November/December 2017 issue of Annals of Family Medicine. Using commercial health insurance claims data from more than 40 million patients at more than 53,000 primary care practice sites across the United States from 2009 to 2011, the authors identified “high value" sites (sites that that ranked favorably for both quality and low total annual per capita spending) and “average-value" sites (sites that ranked near the median for both quality and low spending). Researcher teams comprising one primary care physician with experience in practice assessment and one non-physician qualitative researcher were then blindly assigned to conduct 8-hour visits to 12 high-value sites and 4 average-value sites. During these visits, researchers interviewed staff to help identify attributes that interviewees felt might account for their practice site ranking favorably. Through these interviews and visitations, the authors identified 13 attributes of care delivery that distinguished the high-value cohort. Six of these attributes attained statistical significance: (1) decision support for evidence-based medicine, (2) risk-stratified care management, (3) careful selection of specialists, (4) coordination of care, (5) use of standing orders and protocols to reduce cognitive burden, and (6) balanced physician compensation. In a press release, one of the study's authors, Arnold Milstein, MD, MPH, noted that physicians at high-value sites were implementing a concept known as “care-traffic control," where physicians were “thinking more deeply about what each individual patient needs to navigate in the periods between primary care office visits."

HRC Recommends: Delivering high-quality healthcare at the most affordable cost is a challenge faced by all healthcare organizations. Risk managers at organizations that manage primary care practices may wish to review the above study and determine whether the practices are displaying some of the attributes of high-value organizations identified in the study.