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What is High-Value Healthcare? High-value care is what results when care that is high-quality and lower-than-average total cost intersect.

What is High-Value Healthcare?

In early 2013, the Peterson Center on Healthcare and Stanford University’s Rapture StretchKnit Ankle Boots Stuart Weitzman qUfN8ayWC
set out to find these high-value providers through a systematic analysis of commercial insurance data. Commercial insurancedata reflects market prices, rather than prices set by Medicare and Medicaid, and allows analysis of the “all-in” cost of a primary care physician to his/her patients, including payments for patients’ drugs, emergency room visits, lab testing and other services. The opportunity presented to the Peterson Center on Healthcare and Stanford CERC teams was to:

Stanford’s CERC team systematically identified primary care practices that routinely achieve high performance—high-quality care at a lower-than-average cost. The team first looked at single- and multi-specialty U.S. physician practices with at least two physicians providing primary care. They narrowed the list to those whose performance landed them in the top 25 percent on quality measures. Quality measures were predominantly sourced from HEDIS (Health Effectiveness Data and Information Set)—a universally recognized set used by more than 90 percent of U.S. health plans for assessing quality. Researchers then eliminated all sites where total annual per capita health spending by commercial health insurers did not also fall into the lowest 25 percent—after adjustments to reflect the severity of illness of their patients. Fewer than five percent of the roughly 15,000 sites assessed by the CERC team ranked in the top quartile on quality and the bottom quartile on costs.

Engaging Experts Experts at nationally recognized institutions—including the Harvard T.H. Chan School of Public Health, RAND Corporation, University of Michigan, Yale School of Public Health, and others—helped shape the analytic methods of the CERC team.

Engaging Experts

The second step of the approach was to identify the features or characteristics of these physicians that help explain their exceptional performance. The CERC team conducted a series of in-depth site visits with a sample of high-performance physicians to understand their distinguishing features. For comparison, the team also visited other primary care practices whose quality of care and cost scores were closer to the average.

Through this combination of quantitative and qualitative analyses, the CERC team identified Caterina shoes Coliac di Martina Grasselli AxkBmY
that consistently delivered exceptional value to their patients.

“We found that high-quality care is being provided at lower total annual cost at a small number of primary care practices. Many of these providers were largely unaware that they’re unique, but they are actually doing something extraordinary, and they have a number of features in common that can be replicated.” —Arnie Milstein, Director, Clinical Excellence Research Center, Stanford University

By Vilma Ruddock M.D.

Many people live on the edge of anxiety to one degree or another. Often recurrent or persistent stress, or other underlying causes of anxiety, can lead to chest tightness or pain. Symptoms of chest tightness due to anxiety can mimic symptoms of serious medical conditions and it is not always easy to tell the difference. When in doubt, especially if tightness in chest with anxiety is associated with other symptoms, it is important to seek prompt medical help.


Anxiety by itself can lead to chest tightness as a common symptom. In addition to anxiety and anxiety disorders , any structure in the chest and upper abdomen can also cause tightness in the chest accompanied by anxiety, including the heart, lungs, trachea, esophagus, liver and gallbladder.

Learning some of the differences between anxiety-generated chest tightness and that caused by more serious medical problems, such as heart disease, can be helpful and life-saving when you are faced with these symptoms.

Anxiety can stem from mild, short-lived responses to a threatening situation, which is a normal aspect of survival instincts. Symptoms of anxiety also can be part of a range of persistent anxiety or psychiatric disorders, such as:

Whatever the cause of the cause, common symptoms of anxiety include:

Sometimes there is numbness and tingling in lips, fingers and feet because of the shallow, rapid breathing and inadequate oxygen.

The chest tightness is usually the result of holding chest muscles and rib cage muscles tight, or the disordered breathing.

The symptoms associated with heart disease or a heart attack are often varyingly described as follows:

Other diseases associated with the heart and blood vessels, including a tear in the aorta due to ruptured aneurysm and pericarditis , (an inflammation of the outer lining of the heart), can cause symptoms similar to a heart attack. A ruptured aortic aneurysm is often associated with a sudden severe pain in the back.

Because the symptoms of an anxiety attack and a heart attack or other cardiovascular event are similar, it is better to be cautious and seek immediate help, especially if you have risk factors for heart disease such as diabetes, high blood pressure, obesity and smoking.

Lung or pulmonary disease often leads to shortness of breath, and this symptom can lead to tightness in the chest with anxiety as associated symptoms. These lung diseases include

A pulmonary embolus or an acute asthma attack can quickly lead to death because of lack of adequate oxygen, so, again, it is important to seek emergency treatment.

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, a chronic inflammation of the muscles of the ribs and sternum or persistent contraction of these muscles due to stress, can also lead to chest tightening or pain which my lead to anxiety and mimic symptoms of heart disease. Often these symptoms can be relieved with an anti-inflammatory medicine.

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