We know that Americans spend significantly more on their healthcare, yet are not as healthy as citizens in other high-income countries. But what if the solutions to this ongoing national challenge are hiding in plain sight?
As it turns out, there are bright spots—healthcare organizations whose innovations could help make U.S. healthcare the highest-performing system in the world.
The Peter G. Peterson Foundation's recently launched Peterson Center on Healthcare has been working with Stanford University researchers since early 2013 to identify high-performing primary-care practices and find ways to share the information with their peers.
The most commonly cited examples of high-quality, low-cost care come from well-known, large integrated health systems. But we found that there are also small physician practices delivering equally compelling results on America's “Main Streets.” If we looked at what those practices were doing, could we identify for their peers the secrets to transforming U.S. healthcare? Eighteen months ago, we began combing through commercial insurance data in search of answers to that question.
We analyzed 15,000 primary-care practices and found that fewer than 5% ranked in the top quartile on measures of healthcare quality and the lowest quartile for healthcare spending. Their patients benefit from high scores on quality of care and incur annual healthcare spending significantly lower than patients served by other primary-care sites.
Replicating these results nationally would improve quality while reducing annual U.S. healthcare spending by roughly 10%, saving hundreds of billions of dollars.
We visited a sampling of these sites—including independent primary-care practices, multispecialty group practices, affiliates of large health systems, a workplace clinic and a federally qualified health center—and identified 10 features they shared. These include a judicious use of referrals outside of primary care by performing as many tests and procedures as they can safely perform in-house; systems to ensure patients routinely receive evidence-based care; and an “always on” mentality that maximizes patient access to primary care via same-day appointments and evening and weekend hours. These activities are all supported by teams working in open, “hived” floor plans that support close communication between physicians and their staffs.
While the practices were somewhat surprised to learn that the way they delivered care resulted in both high quality scores and low per-capita healthcare spending, most believed that their job was to achieve the highest quality of care and not waste patients' income on preventable health crises, unnecessary care and unnecessarily expensive services.
For instance, at St. Jude Heritage Medical Group in Yorba Linda, Calif., patients are seen in a transition clinic after a hospitalization, which has reduced readmissions by 40% in the past year. The group also redesigned their office space with patient flow in mind. As a result, there are no waiting rooms, and care teams work together in a shared space, facilitating communication between patient interactions. This layout also has improved physician productivity by 21%.
At Northwest Family Physicians in Crystal, Minn., physicians seek training to deepen their expertise in a medical subspecialty and use it to support their colleagues. This training allows them to perform low-complexity procedures and diagnostics for patients who might otherwise require referral to a subspecialist. The practice also contracts with a cardiologist who reviews echocardiograms and makes guideline-based recommendations on whether patients should be managed internally or referred for cardiology interventions. Physicians also work closely with a team of medical assistants and nurses to offer rapid and responsive access, supported by standing orders and protocols. Well-managed, team-based care enables a four-day workweek for physicians.
Similar innovations were found at all 11 practices we studied. They added up to the 10 shared features uncovered in our findings.
These features are tangible and actionable and therefore likely transferable. Our findings indicate that high-value care is being provided in diverse settings, from large organizations to small physician practices. Better yet, we found that the practices also thrive financially and offer a good quality of work life. Yet, most primary-care sites across the country lack these features and don't perform as well as they could.
We deeply admire these “Main Street” practices, and ask others to join us in the critical next step of this journey: helping all primary-care practices adopt these features associated with higher-quality care at a lower cost.