Hattiesburg Clinic's value-based care journey is a powerful example of the significance of data analysis and the importance of physician-led team-based care. In an effort to address doctor shortages, particularly in primary care, the clinic expanded its care teams with advanced practice providers (APPs). However, internal data revealed that care provided by nonphysician providers working independently was more expensive than care delivered by doctors.
The study, "Targeting Value-Based Care with Physician-Led Care Teams," published in the Journal of the Mississippi State Medical Association, highlights Hattiesburg Clinic's experience. Initially, the clinic employed 26 physician assistants (PAs) and nurse practitioners (NPs) in 2005, growing to 118 by today. Alongside certified registered nurse anesthetists and optometrists, they comprise a team of 186 nonphysician providers.
The clinic's ACO was ranked first in quality among its cohort in 2016 and 2017, with a total of 471 participants, and has been recognized by the Centers for Medicare & Medicaid Services (CMS) for delivering high-quality care at a low cost. However, internal data analysis revealed that per-member, per-month spending was $43 higher for patients whose primary health professional was a nonphysician provider instead of a doctor.
This finding sparked system changes, with leaders redesigning the clinic's care model to prioritize physician-led team-based care. The original intent was to identify high-cost physicians and work with them to reduce spending. However, after receiving CMS reports on care costs, the clinic discovered that four out of five top highest-cost providers were nurse practitioners.
The data analysis revealed a combination of factors contributing to these additional costs, including more ordering of tests, referrals to specialists, and emergency department utilization. Patients who saw a non-doctor as their primary care provider (PCP) had higher rates of ED use than patients without a PCP.
Physicians performed better on nine out of 10 quality measures, with double-digit differences in flu and pneumococcal vaccination rates. They also had higher average patient-satisfaction scores across six domains measured by Press Ganey.
While NPs and PAs are invaluable members of the Hattiesburg care team, data analysis suggests that they should not function independently. The clinic's leaders praised these providers for their adaptability and support during the transition to a physician-led model.
The implementation of this new model was fueled by telemedicine, allowing patients to access care remotely. This change has helped ensure a more cost-effective and high-quality experience for patients.