Health care spending often includes unnecessary or harmful care. Even small improvements in physician performance can significantly reduce costs and improve outcomes. By learning from top-performing physicians, Wisconsin can enhance health care value statewide.

The Business Health Care Group (BHCG), supported by Gates Ventures, Centivo, Baird, and HPS/PayMedix, conducted its third study using Wisconsin Health Information Organization (WHIO) claims data. The goal is to measure physician value and identify opportunities for improvement.

What the Study Shows

• There is no correlation between the cost of care and physician quality.
• If all physicians performed at or above the 50th percentile for cost efficiency – or if patients were directed to those providers – Wisconsin could save $288 million annually for primary care and $106 million for specialty care.
• Better performance means better outcomes for patients statewide.
• Social determinants of health are not significantly impacting physician performance.
• High-performing physicians remain high performing and the lowest-performing physicians stay lowest performing.

How Results Will Be Used

• Help health systems improve performance with physician-specific data via WHIO
• Guide employer benefit design to steer patients to high-value providers
• Support Centivo’s high-performance, primary care-focused health plan for BHCG employers
• Explore how Social Determinants of Health (SDoH) affect physician performance

This study provides a model for evaluating physician effectiveness not only in Wisconsin but nationwide. Want to learn more?