6 attributes that make for a high-value primary care practice

Doctor with patient
The study found high-value practices usually welcome complaints, offer same-day appointments and expanded hours, and are located in modest office space.

Physician practices that are able to deliver high-quality care at the most affordable cost have some common attributes, according to a new study.

Researchers at Stanford University identified six factors that were statistically significant in defining high-value practices, according to the study published in the Annals of Family Medicine.

The researchers, from Stanford’s Clinical Excellence Research Center used never-before-available commercial health insurance claims from 2009 to 2011 from more than 40 million patients and 53,000 primary care practices across the country to identify those that deliver high-quality care with a lower overall cost. They then conducted extensive site visits to determine what those practices were doing differently.


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They identified the following six attributes that set those practices apart:

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

Study author Arnold Milstein, M.D., director of Stanford’s center, said the common themes included the implementation of a concept he termed “care-traffic control.”

“We found that physicians at these sites were thinking more deeply about what each individual patient needs to navigate in the periods between primary care office visits,” Milstein said in an announcement about the study. “Does their illness affect their executive functioning? Are they following through on laboratory tests? Are they taking their medicines as prescribed? Are all the doctors and specialists a patient sees aware of important aspects of their care plan, such as the existence of an advance directive? Although this is unknown territory to physicians in average-performing primary care practices, it is actively surveilled and supported by their high-value peers.”

High-value practices use standard treatment protocols to help care staff and have a system to ensure compensation for physicians and clinicians reflect the quality and affordability of care provided, the study found. Those practices usually welcome complaints, offer same-day appointments and expanded hours, and are located in modest office space.

Given Medicare’s new Merit-based Incentive Payment System that places emphasis on value-based care and health insurers’ narrowing of physician networks, the study said clinicians need to be aware of the attributes that make practices high-value.

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