title: Measuring Physician Quality and Efficiency in an Era of Practice Transformation: PCMH as a Case Study.
abstract: Practicing physicians face myriad challenges as health care undergoes considerable transformation, including advancing efforts to measure and report on physician quality and efficiency, as well as the growth of new care models such as Accountable Care Organizations and patient-centered medical homes (PCMHs). How do these transformational forces relate to one another? How should practicing physicians focus and prioritize their improvement efforts? This Special Report examines how physicians' performance on quality and efficiency measures may interact with delivery reforms, focusing on the PCMH. We note that although the PCMH is a promising model, published evidence is mixed. Using data and experience from a large commercial insurer's performance transparency and PCMH programs, we further report that longitudinal analysis of UnitedHealthcare's PCMH program experience has shown favorable changes; however, cross-sectional analysis indicates that National Committee for Quality Assurance's PCMH designation is positively associated with achieving program Quality benchmarks, but negatively associated with program Efficiency benchmarks. This example illustrates some key issues for physicians in the current environment, and we provide suggestions for physicians and other stakeholders on understanding and acting on information from physician performance measurement programs.
authors.affiliation: UnitedHealth Group, Minnetonka, Minnesota lewis_g_sandy@uhg.com.
authors.forename: Lewis G
authors.initials: LG
authors.lastname: Sandy
authors.affiliation: Optum, Eden Prairie, Minnesota.
authors.forename: Heidi
authors.initials: H
authors.lastname: Haltson
authors.affiliation: UnitedHealth Group, Minnetonka, Minnesota.
authors.forename: Brent A
authors.initials: BA
authors.lastname: Metfessel
authors.affiliation: Optum, Eden Prairie, Minnesota.
authors.forename: Conway
authors.initials: C
authors.lastname: Reese
mesh_terms: D060866:Accountable Care Organizations / Q000592:standards*; D003430:Cross-Sectional Studies; D006801:Humans; D008137:Longitudinal Studies; D019982:Organizational Case Studies; D018802:Patient-Centered Care / Q000592:standards*; D010820:Physicians / Q000592:standards*; D011785:Quality Assurance, Health Care
keywords: benchmarks; efficiency; health care; measurement; patient-centered medical home; practice change; practice-based research; primary care; quality