The healthcare delivery system and payment models are changing. Much more emphasis is being placed on preventative care, engaging patients and their family caregivers as members of the care team, and improving satisfaction and outcomes.

A recent analysis of commercial insurance data provides some hints at what primary care practices (as well as some specialty or multispecialty practices) can do to improve their performance and bottom line. The study found that those practices who consistently delivered exceptional value to their patients spent 58 percent less than those cared by their peers nationally.

The analysis was conducted by researchers at Stanford Clinical Excellence Research Center and the Peterson Center on Healthcare. It looked at the performance of small front-line clinical teams to identify primary care practices that are "positive outliers" in performance — delivering higher quality at significantly lower total annual cost.

Researchers wanted to determine the features that distinguish these primary care practices so other physicians could incorporate insights from these high-value providers into their own practice. They also wanted to demonstrate the replicable nature of these features and results, and support adoption on a national scale.

The researchers looked at small clinical teams rather than large medical groups, because they reflect how the majority of physicians practice today. They also used commercial insurance data for the analysis, because it reflects market prices rather than prices set by the government. This allows for an analysis of the "all in" cost of healthcare, including payments for patients' drugs, ER visits, lab testing and other services.

The 10 distinguishing features of these practices are:

  1. Patients sense that the practice is "always on" and easily accessible.
  2. Physicians adhere to quality guidelines and choose tests and treatments wisely.
  3. They treat patient complaints as gold, and feedback is encouraged.
  4. Insourcing, rather than outsourcing, of tests and procedures is preferred whenever possible.
  5. They carefully select specialists for referrals and stay connected to their patients after referring.
  6. They close the loop on treatment planning and actively follow up with patients.
  7. They maximize the abilities of staff members so each practices at the top of his/her licensure.
  8. They work in "hived workstations" for easy communication and collaboration among clinical and nonclinical staff.
  9. They balance compensation with performance.
  10. They invest in people, not space and equipment.

These findings align with the concepts of patient-centered medical homes and the initiative Choosing Wisely. They also challenge the myth of efficiency coming from the replication of large health systems with scale advantages.

Instead, these practices demonstrate that primary care practices can still deliver exceptional performance. In addition, if these features are applied across the nation, a $300 billion reduction of national spending is estimated.

The challenge to primary care leaders is establishing a culture that encourages continuous performance improvement among the team and the application of best practices. These 10 features are certainly best practices that primary care physicians should consider for their small practices..