Improving Physician Health Care Value
A top priority of BHCG and its member employers is to purchase high value health care. To evaluate the quality and cost effectiveness of care provided by physicians throughout Wisconsin, BHCG has commissioned Physician Value Studies from Aitia, a leading provider of artificial intelligence and advanced data analytics methods in health care.
WHIO Data Set — A Comprehensive Source
The studies draw upon data from the Wisconsin Health Information Organization (WHIO) which maintains Wisconsin’s All-Payer Claims Database (APCD), the state's most comprehensive source of health care data and information. It represents the majority of covered lives in the state, providing data and information to assess the quality, safety and cost-efficiency of health care delivered in the state.
PVS 1.0 & 2.0 — Opportunities to Improve Value
Physician Value Study (PVS) 1.0 in 2019 found profound levels of variability in both quality and cost-efficiency of physicians in the state. In 2021, BHCG commissioned Physician Value Study 2.0, again using WHIO’s extensive all-payer claims database with multiple years of data. The Study provided actionable results at an individual physician level. Key observation included the following:
- There was almost no correlation between quality and cost-effectiveness of primary care physicians (PCPs)
- There was substantial variation across specialists in the cost-effectiveness of care
- Savings of over 26 percent or approximately $382 million ($325 million with PCPs and $57 million with specialists) of the $1.5 billion spent annually could be achieved by improving performance of both PCPs and specialists to the 50th percentile or higher; and/or through patient steerage.
Results of PVS 2.0 were used to:
- Develop WHIO’s Physician Value Reports to support health system performance improvement
- Assist Centivo in the development of the BHCG-Centivo high performance health plan solution designed to support better health care decision-making, particularly with respect to the steerage of patients to higher-value providers.
PVS 3.0 — A Roadmap to Impact Change
In 2025, using 2021-2022 data from WHIO, BHCG commissioned Physician Value Study 3.0, with generous support from sponsors Gates Ventures, Centivo, Baird and HPS/PayMedix. PVS 3.0 reaffirmed there was almost no correlation between quality and cost-effectiveness of PCPs and there was substantial variation across specialists in the cost-effectiveness of care. The annual potential cost savings for improving PCP and specialty physician performance (for 11 high-volume procedures) up to the 50th percentile was estimated at $394 million, a 31.1 percent cost savings.
Results from PVS 3.0 will be used to:
- Support health system improvement efforts
- Guide employer benefit plan design to support better health care decision-making
- Inform Centivo to continually enhance its high-performance, primary care-centered health plan
- Identify Social Determinants of Health (SDoH) to understand the impact on differences in physician performance.