The Business Health Care Group announces third version of groundbreaking physician value study measuring physician performance
Milwaukee, WI – September 24, 2024 – The Business Health Care Group (BHCG), a coalition of employers in Wisconsin serving as a collective action group to influence the quality and cost of health care in the region, is launching the third version of its Physician Value Study (PVS 3.0). The Study seeks to measure physician performance (quality and comparative cost) to improve outcomes and lower the cost of care. PVS continuing sponsors BHCG and Centivo welcome new co-sponsors Gates Ventures, Baird and HPS/PayMedix to the third version of the study.
What is the Physician Value Study?
In the absence of adequate information to create a consistent, robust and comprehensive model to evaluate health care value, BHCG commissioned its first Physician Value Study (1.0) in 2019. The study, conducted by precision medicine company Aitia (formerly GNS Healthcare), leveraged causal learning, a powerful type of artificial intelligence (AI). Causal learning enables the use of simulations to answer “What if?” questions, such as, ‘If Dr. X performed like Dr. Y, what would patient outcomes be?’ It also allows for powerful casemix adjustment to ensure providers’ performance is being evaluated on comparable patients.
“The results of Physician Value Studies 1.0 and 2.0 confirmed we are on target with our mission to use technology to understand how and where the best care is delivered to improve the value of health care,” said Jeffrey Kluever, executive director of BHCG.
“We are pleased and grateful our sponsors as well as health system leaders in Wisconsin understand the importance of continuing and enhancing the Physician Value Study’s information output to benefit all health care stakeholders – most especially, employers, employees and their families, health care providers and our broader communities.”
How is the Study Performed?
The claims data and social determinants of health (SDOH) information used for the Physician Value Study is provided by the Wisconsin Health Information Organization (WHIO). WHIO’s All-Payer Claims Database (APCD) is the largest source of health care data and information in Wisconsin. The WHIO APCD includes data for all care settings representing 5.36 million insured
lives, $375 billion in charges and 866 million claims.
The WHIO information (de-identified so that individual patients cannot be recognized) tracks an entire episode of care from start to finish and identifies the best results achieved by doctors across the state. This information can then be used to improve practice patterns and get patients to the most effective providers. The study reviews the performance of primary care physicians (PCPs), as well as a segment of specialty providers who perform procedures that account for most of the spending on specialty care. The study results can also be used to inform provider referrals from on-site and near-site employer clinics, which are common in the Wisconsin employer community.
What Did PVS 1.0 and PVS 2.0 Tell Us?
The first two editions of the Physician Value Study showed the potential for very substantial cost savings through improved physician performance – a leading goal of the BHCG-Centivo high-performance, primary care-centered health plan. BHCG and strategic partner Centivo used the Study results as the foundation to develop the plan that purchases health care for value, supports clinically integrated health care models and a fruitful dialogue between payers and the provider community.
What’s New in PVS 3.0?
To continue to enhance the value of the Study, three additional elements are to be included in PVS 3.0. These are:
- Inclusion of newly available SDOH data to continue to inform the differential performance of physicians measured in the study and understand the degree of impact of SDOH differentials on physician outcomes.
- Updated claims information from calendar years 2021 and 2022 to allow for comparative assessment of physician performance and determine the consistency of quality and cost-efficiency versus the PVS 2.0 study periods.
- Discussions with chief medical officers of leading health care systems in Wisconsin through an advisory panel that will provide input to Aitia on Study design.
Earl Steinberg, MD, MPP, a nationally recognized expert on evaluation of physician performance, will again serve as the lead investigator for the Study, as he did for versions 1.0 and 2.0.
“The Physician Value Study provides an extraordinarily robust template for the evaluation of physician effectiveness, addressing many of the issues raised in other studies of this type. It can serve as a basis for many potential beneficial outcomes,” said Dave Osterndorf, BHCG strategic consultant and Centivo chief actuary.
Key potential outcomes of the Study include:
- Structuring of continuous improvement models within physician practices to enhance the value of care being provided by primary care physicians and select specialists.
- Development of progressive employer health plan offerings capable of steering patients to higher-performing physicians and paying those providers in line with the value they deliver rather than the volume of services provided.
- Identification of gaps in the care provided by particular physicians.
Results of the 3.0 study are expected to be released in the fourth quarter of 2024. A series of meetings to present the results to all interested stakeholders will be held in Milwaukee, Madison, central Wisconsin and northeastern Wisconsin. As it did with previous Study results, BHCG will ask Centivo to use the updated data for BHCG-Centivo high-performance health plan network development.
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About Business Health Care Group
BHCG leverages member employer purchasing power and knowledge to lead change. The organization creates value through innovative, shared strategies to improve health care quality and cost efficiency for employers, employees and the community. BHCG membership is available in Wisconsin and also nationwide for employers accessing BHCG best-in-class strategic partners. Visit BHCGWI.org to learn more.
