Mak­ing progress in shift to value-based care de­spite some per­sis­tent bar­ri­ers

Modern Healthcare - - Comment - By Drs. Michael Munger and Roy Bev­eridge

With health­care costs sky­rock­et­ing and the health of Amer­i­cans suf­fer­ing amid a frag­mented sys­tem, there’s a crit­i­cal need to shift to a pa­tient-cen­tered health­care sys­tem fo­cused on out­comes and the value pa­tients re­ceive for their health­care dol­lar. Fam­ily physi­cians are do­ing more than ever to tran­si­tion to a value-based model of care, but many bar­ri­ers still ex­ist.

Two years ago, we wrote about a study the Amer­i­can Academy of Fam­ily Physi­cians con­ducted on be­half of Hu­mana among 600 fam­ily physi­cians. The study showed that 1 in 3 physi­cians were ready to make the move away from the fee-for-ser­vice model and en­ter value-based pay­ment re­la­tion­ships with pay­ers. It was a hope­ful sign we were mov­ing to­ward in­te­gra­tion rather than frag­men­ta­tion, and to­ward keep­ing peo­ple healthy rather than treat­ing them once they were sick.

Since then, more progress has been made. In 2017, we con­ducted a fol­low-up study of 386 fam­ily physi­cians. It showed more physi­cians were en­ter­ing value-based pay­ment agree­ments and in­vest­ing re­sources—hu­man and tech­no­log­i­cal—to help them iden­tify at-risk pa­tients to stem the pro­gres­sion of their dis­eases. In ad­di­tion, the study showed that more than half of fam­ily physi­cians par­tic­i­pate in value-based pay re­la­tion­ships. Ad­di­tion­ally, half be­lieve that such mod­els will lead to more col­lab­o­ra­tion be­tween pri­mary-care physi­cians and sub­spe­cial­ists.

In the new study, fam­ily physi­cians re­ported they were in­vest­ing in tools to help them thrive un­der a value-based re­im­burse­ment model. Specif­i­cally, they’re putting more prac­tice re­sources into pre­vent­ing ill­ness. Four out of 10 re­spon­dents re­ported they had hired, or plan to hire, care man­agers or co­or­di­na­tors, up from 3 out of 10 in 2015. Ad­di­tion­ally, 3 out of 10 re­spon­dents re­ported pro­vid­ing care-man­age­ment or care-co­or­di­na­tion ser­vices to all

of their high-risk pa­tients, com­pared with 2 out of 10 in 2015.

Fam­ily physi­cians are also in­vest­ing in tech­nol­ogy that will al­low for value-based pay­ments, with more than half re­port­ing their prac­tice is up­dat­ing health IT in­fras­truc­ture or data man­age­ment and anal­y­sis to be bet­ter able to show how they’re meet­ing qual­ity met­rics.

One of the big­gest shifts we saw be­tween 2015 and 2017 was the in­crease in value-based pay­ments reach­ing the hands of physi­cians. In 2015, when asked how value-based pay­ments are dis­trib­uted within the prac­tice, fewer than 2 in 10 re­spon­dents said pay­ments were dis­trib­uted to the physi­cians based on achiev­ing qual­ity and/or out­come targets. In the 2017 sur­vey, nearly 4 out of 10 physi­cians said these pay­ments were dis­trib­uted to physi­cians within their prac­tice.

While these are hope­ful signs, it was less heart­en­ing to see in the study that many of the same bar­ri­ers to tran­si­tion­ing to value-based pay­ment still per­sist. Some of these are re­sources-based—a stag­ger­ing 9 out of 10 physi­cians sur­veyed still cited a lack of staff time as a ma­jor bar­rier. And about 1 in 10 physi­cians re­main skep­ti­cal that the strat­egy will im­prove pa­tient health, cit­ing a lack of ev­i­dence.

Many physi­cians also in­di­cated skep­ti­cism about the im­pact the re­im­burse­ment model would have on the health of their prac­tices. They pointed to a lack of trans­parency be­tween pay­ers and providers, com­bined with a lack of stan­dard­ized per­for­mance mea­sures. Only 8% of fam­ily physi­cians agreed with the state­ment “qual­ity ex­pec­ta­tions are easy to meet in value-based pay­ment mod­els,” even lower than the 13% who agreed with the state­ment in 2015.

We can and must ad­dress these is­sues to im­prove our health­care sys­tem. It’s cru­cial that we stan­dard­ize and sim­plify the value-based re­im­burse­ment mod­els, while at the same time im­prov­ing data trans­parency so that physi­cians have the in­for­ma­tion they need to im­prove the health of their pa­tients.

Sim­ply put, value-based care will never suc­ceed if it is a bur­den on the physi­cian and care team. The value-based model should in­stead be one that re­duces the bur­den on physi­cians, al­low­ing them to fo­cus on what they care about most—their pa­tients. ●

Dr. Michael Munger, left, is pres­i­dent of the Amer­i­can Academy of Fam­ily Physi­cians and Dr. Roy Bev­eridge is chief med­i­cal of­fi­cer of Hu­mana.

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