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 two Physician Value Studies from Aitia, formerly GNS Healthcare, a leading provider of artificial intelligence and advanced data analytics methods in health care.
Using the extensive all-payer claims database from the Wisconsin Health Information Organization (WHIO), Physician Value Study 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 Physician Value Study 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.