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Steps for Accountable Care
There is a notable gap in our system wide efforts to promote accountable, patient-centered care: physician selection.
The past decade has borne witness to significant advances in reorienting the processes and experiences of care
around patient preferences and values, but the same level of focus has not been directed to helping patients identify
the best physician for their needs. Instead, our prevailing approaches to matching patients with physicians remain
largely agnostic to variations in patient preferences, tethered to the traditions of peer recommendation and reputationbased referral. Even recent efforts to bring more transparency and consumer choice to healthcare decisions focus
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primarily on costs and outcomes, and neglect other domains of the patient experience.
This eschews a growing understanding of the divergent priorities many patients have when selecting a physician.
Some patients place a premium on clinical reputation and technological advancement, while others are concerned
more with measures of quality and value. These preferences are layered on top of additional dimensions as varied as
communication style and cultural appropriateness.
Appreciating and acting on this heterogeneity is essential to improving patient ability to interact with the system and
identify clinicians that best fit their needs and preferences. Strengthening the attention to patient preferences in this
critical first step of a patient’s healthcare experience is critical if patients are going to become engaged partners in
their care and form strong therapeutic alliances with their physicians. As accountable care, value-based purchasing,
and other new models of care delivery and financing intensify our focus on patient-centered care and longitudinal
relationships with physicians, it is necessary to improve the healthcare system’s capacity to match patients with
physicians who fit their specific needs, preferences, and values.
In this perspective, we draw on the insights from research into patient preferences to propose a framework for
understanding and organizing the information necessary to successfully match patients and physicians. Specifically,
we outline 5 factors that should be considered when matching patients with physicians, and provide examples of the
information and attributes that are important to consider within each factor.
1. Communication and decision making. Communication and decision making anchor the patient-physician
relationship, and patient preferences in these areas vary considerably. Physician communication style and the tone of
patient interactions, inclusiveness of the patient in decision making, and attitudes and approaches to uses of clinical
evidence are all important variables to consider when selecting a physician. Clinical measures of individual physician
performance or survey data from other patients can be important supports to patient choices in this area.
2. Therapeutic approach. For many elective, “preference-sensitive” conditions, the aggressiveness and intensity of
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treatment vary among physicians. These are precisely the procedures for which patients spend the most time trying
to identify the right physician, and it is important that patients understand with clarity the therapeutic options favored
by their physician of choice. Similarly, a physician’s willingness to provide complementary or alternative therapies,
and his or her use of new technologies or investigational drugs and procedures, are important factors of consideration
in this area.
3. Social and cultural appropriateness. Patients should be matched with physicians who can deliver care that is
consistent with their social, cultural, or religious preferences. For example, patients from historically disadvantaged or
marginalized groups are often more comfortable working with physicians with a special aptitude for or interest in
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working with those groups. Other factors many patients will find important to consider are nationality, ethnicity, or
fluency in their preferred language.
4. Cost and value. Economic considerations have a profound effect on healthcare-seeking and -utilization
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activities. As out- of-pocket deductibles rise and patients increasingly bear the costs of care, appropriate financial
data, such as expected or estimated out-of-pocket costs, will be key variables to consider in choosing a physician.
5. Practice environment. The attributes of the system within which a physician practices have a profound impact on a
patient’s experience with his or her physician. Patients are sensitive to system characteristics such as wait times, the
use of patient portals, physician use of electronic health records (EHRs), and the care delivery model in which the
physician operates (eg, medical home). Many patients—especially patients with complex illnesses—are especially
cognizant of the extent to which clinical interactions across an extended delivery system are coordinated.

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