Q&A: ABFM develops quality measure to assess continuity of care

ByEmma Bascom

ByBob Phillips, MD, MSPH

Fact checked byCarol L. DiBerardino, MLA, ELS

Key takeaways:

The American Board of Family Medicine has developed a measure to examine continuity of care.
Eight in 10 physicians said continuity of care is a better measure of their work than most other quality measures.

Higher continuity of care has consistently been linked to better patient outcomes, according to experts.

Previous research has suggested that continuity of care — the ongoing relationship between patients and their physicians and a core attribute of high-quality primary care — plays an essential role in health care.

In December, researchers from the American Board of Family Medicine (ABFM) published an article in Annals of Family Medicine describing their work on a continuity of care quality measure that was found to meet or exceed acceptable criteria to be implemented in primary care practices.

New survey findings on continuity of care from the ABFM is forthcoming, so Healio spoke with Bob Phillips, MD, MSPH, director of the ABFM’s Center for Professionalism and Value in Health Care, to learn more about how a strong patient-physician relationship impacts care.

Healio: How does the continuity measure assess physician-patient relationships?

Phillips: The continuity of care measure is a measure of continuous physician-patient relationships. It examines whether a patient saw primary care doctors other than their regular doctor — either in a physician practice or a health system. This measure is particularly powerful in an all- or cross-payer context, meaning where the claims data from different health systems and/or different insurers are pooled together. That’s because the evidence shows that continuous relationships viewed across all primary care physicians seen by a patient, regardless of payer, have the largest benefits in terms of lower costs, better health, patient satisfaction and diagnostic accuracy, and early mortality.

If you want to get really technical: The measure is calculated using the Bice-Boxerman index, a validated scale that ranges from 0 to 1; 0 reflects completely disjointed care (a different physician for each visit) and 1 reflects complete continuity with the same physician for all visits that year. The data we have in our PRIME Registry of primary care clinicians show that patients don’t always see the same doctor for various reasons, and that’s okay. So, we set a 0.7 performance threshold to help incentivize continuous relationships, while accounting for the circumstances where a patient might need to see a specialist or another doctor.

Healio: Has this measure been tested? What were physicians’ experiences with it?

Phillips: Yes, the measure has been tested using Medicare data, all-payer claims and also, we have studied it extensively in our PRIME Registry — a nationwide registry of electronic health record data from primary care clinics in nearly every state. The measure is also backed by a substantial body of research showing that when patients and family caregivers are part of an ongoing, long-term relationship with a physician, their health is better in a wide range of chronic disease areas, including diabetes, asthma, cancer and dementia. We know there is also great evidence that continuous doctor-patient relationships also lead to lower costs, including total costs, ED costs, nursing home costs and hospital admissions costs, as well as lower utilization. Further, we know continuous relationships are also associated with higher patient satisfaction and improved life expectancy, whereas the loss of longitudinal relationships in primary care results in $979 million in excess health care expenditures for public and private payers annually.

In terms of physician’s experiences with the measure, recently, we conducted a first of its kind national survey of diplomates of the ABFM, which shows eight in 10 doctors believe that continuity is a better measure of their work as a primary care professional than most other quality measures used by health plans, including Medicare. Survey respondents also report continuous doctor-patient relationships over time are important when it comes to improving diagnoses (99.7%), helping patients change behavior (99.8%), preventing or reducing burnout (97%) and improving patient health (99.8%).

Healio: What is ABFM doing to encourage health plans to incorporate the measure?

Phillips: We have been educating and promoting the measure to commercial health plans as well as Medicare for the past 2 years because in order to strengthen primary care, we need to pay primary care doctors differently. Right now, there are no payment programs that incentivize the things primary care is best at, like maintaining continuous relationships with patients. This is exactly why we developed not only this measure of continuity, but also a “Measures That Matter for Primary Care” portfolio so that things like trust and person-centeredness — things we know patients and families want — can all be prioritized over many of the less meaningful quality measures we see out there today. As the nation’s board certification entity for family medicine physicians, this is something we care deeply about.

To date, the continuity of care measure has been adopted by PRIME Registry, the largest national qualified clinical data registry of primary care clinicians and was endorsed by the National Quality Forum. We are also excited that the measure was accepted into the Core Quality Measures Collaborative’s (CQMC) core measure set last month. This is a major milestone in our goal of advancing this measure into federal, national and state payment programs. The CQMC program is helping all health plans to align with priority areas like continuity of care.

Healio: What other efforts are underway to improve the physician-patient relationship?

Phillips: Currently, the ABFM’s Center for Professionalism and Value in Health Care (CPV) is working directly with primary care physicians to provide resources they can use to communicate the importance of continuous physician-patient relationships to key stakeholders. CPV is working to reduce the negative impact health record systems have on patient care and that can interfere with the doctor-patient relationship. The most potent way to improve relationships, though, is to have the continuity measure implemented so that it is reinforced and supported by health systems and payors.

Healio: Do you have to be part of value-based care to get reimbursement for this, or can you be in a fee for service model? Similarly, if doctors meet the measure’s goals, if they can prove they’re maintaining continuity of care, is that part of their reimbursement?

Phillips: The health plans who pay you would have to adopt this measure into their programs, which they could do under fee-for-service or value-based care models. Continuity is not a new measure but it is relatively new as a quality measure, so we are working hard to promote it to health plans and other stakeholders. For example, the state of Massachusetts recently included the measure concept in some legislation that was introduced, so we are hopeful that with the inclusion of the measure in the CQMC Core Measure Set, many health plans will adopt and use it. This cannot just be another burden for physicians. Supporting continuity means changing schedules and honoring patient and physician desire for these relationships. Currently, most scheduling systems are designed to keep doctors’ schedules full, increasing patient wait-times to see their doctor. Many physicians do not have the autonomy or resources to work against this. So, it is not enough for it to be a physician-level measure; it must be a value and an accountability of the systems they increasingly work in.

Healio: Is there anything else you would like to add?

Phillips: It’s clear that physicians and patients alike understand the power of the doctor-patient relationship, and that they want the health care system to do a better job of supporting it. In our recent survey, physicians said that they think this is a better measure of their work than most of the measures health plans and others use today. Physicians who want to advocate that health plans promote this measure of continuity can reach out to us for help at MeasuresThatMatter@theabfm.org.

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Sources/Disclosures

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Source:

Healio Interview

Disclosures: Phillips reports no relevant financial disclosures.

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Q&A: ABFM develops quality measure to assess continuity of care

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