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Guest Commentary: Making progress in shift to value-based care despite barriers

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.



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