Most physicians don't think value-based payment models work

A majority of physicians don't believe pay for performance programs are effective solutions for quality improvement and cost control, according to a new survey from Leavitt Partners.

Just 22% of the 621 doctors surveyed thought accountable care organizations would lower spending, and 21% supported using bundled payments to drive down costs. At the same time, 29% of doctors thought both ACOs and episode-based payment would improve patients' health outcomes.

Physicians' apprehension toward these models is likely because most don't have much knowledge or experience in them, said David Muhlestein, an author of the report and chief research officer of Leavitt Partners.

Although the number of participants in bundled payments and ACOs is growing, learning what works and what doesn't "hasn't been efficiently conveyed to the participating organizations and the non-participating organizations," he said.

And even within organizations that have adopted these models, physicians aren't often actively engaged in process changes. That is usually left to hospital leaders and administrators.

"Once you talk to the physicians themselves, not very many of them can articulate what the changes are; that is why they don't see it as positive," Muhlestein said.

Few doctors understand the requirements of the Quality Payment Program as well; 47% of physicians surveyed said they have heard of MACRA but are not familiar with the requirements. Only 4% said they have in-depth knowledge about the law.

Administrators should discuss these models more with physicians and also address how it will affect them personally, Muhlestein said. The hope is the models transform how care is delivered, he said, "so connecting the payment reform to the delivery reform, and helping doctors understand the connection is important."

The report also surveyed 538 employers and 5,031 consumers. It found that most consumers—about 70%—thought either fundamental changes are needed in the healthcare system or "the system needs to be completely rebuilt."

Even though most consumers felt that way about the industry overall, 72% said that their health insurance plans meet their family's needs very or extremely well, the report said.

"There is a disconnect," Muhlestein said.

The personal satisfaction consumers have with their health insurance coverage is likely why healthcare delivery reform isn't moving quickly, he said. If insurers and employers find their members are happy with their coverage, they will be less willing to make changes.

"Until consumers believe there needs to be a change, there isn't going to be a lot of pressure," Muhlestein said. "I think it's an important takeaway—as long as consumers are generally satisfied we won't get to the point where we can drive through reforms that are going to effect payment and delivery."