Grand Rounds Primary Care Quality Map: How Does Your County Rank?

By Sasha Small
May 7, 2018

How do you find your doctor? Most of us seek recommendations from friends and family or take a gamble on a Google search. The process is long and riddled with incomplete and inaccurate information. At Grand Rounds, we’re focused on using data to answer this question for people across the country.

Grand Rounds partners with more than 100 leading employers to help their employees and dependents find high-quality, in-network providers, and to seamlessly navigate their health care journey—for medical needs big and small.

Today, we released an interactive quality map to demonstrate the power of access to provider-level quality data, impacting care where it matters most: between a patient and their provider. The county-level map provides an at-a-glance view of access to primary care physicians (PCPs) ranked in the top 25% in each state.

Why we built the map

While our services reach over 3.5 million covered lives, we identified a need to share a glimpse into this data with a wider audience, aiming to spark a critical conversation around variations in provider quality and the impact on care outcomes.

For this initial launch, we chose to analyze variation in primary care quality because PCPs play an essential, and often underestimated, role on the front lines of American health care. Studies suggest:

  • U.S. adults who have a PCP have 19 percent lower odds of dying and 33 percent lower health care costs than those who see only specialists.1
  • People in the U.S. alone would save $67 billion each year if every individual used a PCP as their usual source of care. Some of these savings result from PCPs delivering more effective management of chronic illnesses.2
  • A well-managed case of diabetes may cost $12,000 per year, but poorly controlled cases can reach more than $100,000 per year. With their frequent assessment of patient activities, PCPs can adjust treatment as needed before cases reach more critical levels requiring emergency intervention.3

Even more, Grand Rounds analyses show that quality plays a big role in PCPs’ clinical judgment. For example, top-decile PCPs are 3x less likely to prescribe highly addictive anxiety medications and opioids than their bottom-decile peers. And patients who see high-quality PCPs are 15% more likely to get preventative colon cancer screenings than those who see low-quality PCPs.

How we built the map

Grand Rounds focuses on understanding provider quality specific to a member’s needs at a given point in time. We believe that quality isn’t just a supply issue, but also a matching problem—getting the right provider matched with the right patient. For example, someone seeking primary care for a complicated chronic illness has different needs compared to someone who is healthy and needs an annual physical exam.

To show how quality care is distributed across the country, we generate various average member profiles and rank regional PCP quality for those member profiles. While the map shows the availability of top-quality PCPs for an average patient in each state, patients using Grand Rounds’ matching engine are connected to the best available PCPs for their own needs and preferences, tailoring the definition of “quality” to each individual.

Our proprietary algorithms use clinical data (e.g., prescribing rates, preventive screening rates, medication adherence) along with background data (e.g., practice affiliations, board certifications) to predict physician performance according to various dimensions. Then, the relative importance of these dimensions is determined based on population-level impact. By doing this, the algorithms are able to identify PCPs who are most likely to deliver high-quality care consistently.

We used our algorithms to determine how PCPs within each state would rank for an average patient profile. Then for every state, we ranked the counties based on the number of top-quality (ranking in the top 25% of their state) PCPs per capita. Scaling by population allowed us to account for variations in population density across counties. The map provides data for more than 2,300 counties that have at least three individual PCPs, representing about 75% of all U.S. counties, and accounting for more than 98% of the U.S. population.

What does it mean?

Counties are color-coded according to their relative density of top-quality PCPs, compared to the other counties in their state. In each state, the map sheds light on counties where residents may face limited access to high-quality PCPs and areas where there are higher concentrations of quality but potentially more noise leading to confusion and frustration as consumers decide on the best care path. For example, in California, counties in the Bay Area tend to have the highest density of top-quality PCPs, Los Angeles has a slightly lower density, and San Bernardino is ranked below-average.

While certain counties may have a higher or lower supply of top-quality PCPs on average, there is substantial variation in quality across individual doctors within any given county. In fact, excellent PCPs can typically be found in even the lowest ranked counties. Similarly, in areas with many high-quality options, the challenge is to match each patient with the individual doctor who is best suited for his or her needs. Grand Rounds has built tools for our members to identify and seek care from the best providers in their areas and for their specific needs, so they can access great quality doctors even if they aren’t prepared to travel elsewhere or pursue virtual care.

The interactive quality map illustrates the importance of navigating health care through objective, provider-level quality data. Deciding whether and where to receive health care is one of the most important decisions we make, after all.

See PCP Quality Map

Source

  1. B. Starfield, L. Shi, and J. Macinko, “Contribution of Primary Care to Health Systems and Health,” Milbank Quarterly, Sept. 2005 83(3):457-502
  2. B. Starfield, L. Shi, and J. Macinko, “Contribution of Primary Care to Health Systems and Health,” Milbank Quarterly, Sept. 2005 83(3):457-502
  3. Primary Care: Our First Line of Defense,” The Commonwealth Fund, June 12, 2013
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Sasha Small

Sasha Small

Sasha is a senior analyst at Grand Rounds. Prior to Grand Rounds, she held similar roles in finance and mental health care. She is cautiously optimistic about the potential to heal the wounds of our health care system, by combining technological innovation and empathetic patient care.