We all know the key role primary care physicians can play in quarterbacking patient care and aligning the scattered pieces of the team. But less discussed, perhaps, is their untapped ability to save the U.S. health care system hundreds of billions of dollars, just through spreading best practices.
Pockets of primary care excellence are scattered across the country. To uncover those hidden gems, researchers from the Stanford University Clinical Excellence Research Center recently scoured health insurance data on some 40 million Americans, seeking any commonalities. Last week, researchers released a list of 11 of the highest-performing primary care groups, along with 10 common practices they share in their quest to improve care.
If those best practices — which include everything from longer hours, to embracing patient complaints — were scaled across the industry, the U.S. health care system could save upward of $300 billion, researchers estimate.
"There are these hidden gems that Stanford uncovered in its research that we believe can become the norm," says Jeffrey Selberg, executive director of the Peterson Center on Healthcare, which funded the study. "The issue for us is that they're just pockets, and our interest in collaborating with the Clinical Excellence Research Center is figuring out how you spread and scale these pockets, such that, rather than representing 5 percent of providers, they represent, over time, 95 percent of providers."
Stanford looked at 41 quality metrics and data on total spending from 15,000 different practices with at least two docs' providing primary care. As Selberg mentioned, they found that fewer than 5 percent of those ranked at the top of the list in terms of quality, and bottom of the list in terms of costs. The 10 common actions among those practices, which Stanford sees as a blueprint for success elsewhere, are:
- Widening hours: Patients can easily schedule same- or next-day appointments, and docs are reachable throughout the day.
- Choosing wisely: Physicians stick to quality guidelines and carefully pick which tests or treatments to use in their practice.
- Favoring feedback: Docs in the top performers actively seek out criticism and tailor their operations to customer opinions.
- Sticking in-house: Where possible, tests and procedures are performed within the practices, rather than farmed to outside third parties.
- Staying in touch: Docs only refer patients to a specific group of specialists, and they monitor care closely outside the practice.
- Closing loops: After discharge, physicians ensure that patients stick to follow-up appointments and take their meds.
- Maximizing staff: All clinicians, such as nurse practitioners and physician assistants, are allowed to practice to the top of their licenses.
- Collaborating closely: Clinicians in the top practices work in an open, hivelike environment that encourages communication across the entire team.
- Paying on performance: Compensation in leading primary care groups is based on the quality of care, among other factors, rather than just productivity.
- Focusing on people: Leaders in primary care direct dollars toward the staffers who make a patient encounter click, rather than space, equipment and technology.
Stanford is now working with the Peterson Center on Healthcare on a plan to disseminate the study findings, and put those best practices to use sometime in the first half of 2015. Stanford's research center also hopes to compile similar lists of best practices for other parts of the health care industry, such as medical specialty practices. Selberg is eager to move into the next phase of the process.
"It's an exciting time for us. We're really quite optimistic and hopeful that this works," he says.