Why is the Value-Based Care Adoption Rate Low?
A new AJMC study examined the challenges that physicians face when it comes to creating value-based care.
- One of the hottest trends in 2014 has been the increased focus on value-based care platforms instead of the fee-for-service approach. One of the main results of the Affordable Care Act (ACA) is the creation of Accountable Care Organizations and other tactics, which push a healthcare system that focuses on keeping patients healthy and out of hospitals.
In a recent report from the American Journal of Managed Care (AJMC) examined the shift to value-based care and the challenges that practices face when it comes to implementing the strategy. The report analyzed five nationwide surveys that were fielded by 90,563 Medscape physician members across 25 specialty areas. This represents 60 percent of the total American Medical Associations active physicians and a large number that are not AMA members. These studies examined compensation, number of hours worked, practice changes resulting from healthcare reform, and adaptations to the new healthcare environment.
“Despite the function of these new payment models as engagement/reinforcing mechanisms, there is currently limited physician participation in new models of delivery; there is also lower-than-anticipated data reporting for reimbursement programs,” the report reads. “Although ACOs have increased in number, currently only approximately a quarter of physicians are in ACOs.”
The begs the question of why is physician participation slow to pick up? The report points to five specific areas, these include:
Change fatigue – While many people will argue that change is good, too much at one time can cause overload. The significant changes linked to the Affordable Care Act and the weight of new reporting regulations and performance metrics have physicians overwhelmed.
Complex policies – Healthcare is as highly regulated as any industry and is deeply impacted by every new policy. These can be represented by dozens of acronyms and other complex jargon. The significant changes mentioned above bring a number of new policies at once. This is creating friction for physicians as they try to understand all of the new policies, exemptions and penalties.
Unclear successful pathways – With new metrics, there is going to be those that look for success stories to help them navigate the path. However, the current metrics show there is a mixed reaction to how to succeed in the face of a new paradigm.
Concern over “cookbook” medicine – There is a fear that evidence-based medicine can be reductive, thoughtless “cookbook” medicine. This is because opinions expressed about evidence-based medicine is often cautionary, warning about clinical guidelines. There is concern that reducing these guidelines into hard-and-fast rules could cause more problems as they will not address specific patient needs.
Trends in PCP compensation – While primary care providers (PCPs) have experienced success with value-based models, their overall compensation lags well behind other specialties.
“Physician engagement in healthcare reform is largely being incentivized via pay-for-performance models and metrics,” the report concludes. “There is currently little evidence that health systems have sustainable plans to engage physicians beyond performance incentives. Targeted physician engagement strategies—continuing medical education, for instance—have been shown to be drivers of healthcare transformation.”
