Physician Survey Indicates Incremental Progress in Shift to Value-Based Pay

11/30/17 | Heather Landi

A survey of 386 family physicians conducted by the American Academy of Family Physicians (AAFP) and Humana indicates a growing acceptance of value-based payments, reflected in IT, care coordination and other investments, yet major barriers still exist.

The new AAFP and Humana survey, a follow-up from a 2015 survey, shows more family physicians transitioning to value-based payment models, as 54 percent of respondents indicate their practices participate in value-based models, and half believe these models will encourage greater collaboration between primary care physicians and specialists.

The 2017 Value-based Payment Study was sent to 5,000 active members of the AAFP. A total of 482 surveys were returned, and 386 were evaluated after a screening process.

The survey found that 47 percent of family physicians said they are actively pursuing value-based payment opportunities, compared to 44 percent in 2015. What’s more, 37 percent of respondents said that value-based payments are distributed to family physicians based on achieving quality and/or outcome measure targets, an increase from 18 percent as reported in 2015. And, 33 percent said value-based payments are distributed to family physicians in a transparent manner, compared to 12 percent two years ago.

When respondents were polled as to the reasons why their practice does not have a strategy toward value-based payment, only 9 percent said there was not enough evidence to support value-based payment, a decrease from 17 percent in 2015. Thirty-three percent of physicians said they are too busy and overwhelmed to think ahead, which grew from 21 percent in 2015. And, 18 percent said value-based payment is too risky, compared to only 7 percent in 2015.

Taking a look at investments and resources that family physicians are dedicating to value-base payment models, 32 percent of family physicians report that they provide ongoing care management or care coordination services to all high-risk patients, an increase from 23 percent in 2015. Forty-three percent cite hiring/hired care management and care coordinators, compared to 33 percent in 2015.

The survey also found that more than half (54 percent) of family physicians are in a practice that is updating or adding health IT infrastructure for data management and analysis to participate in value-based payment.

However, the same barriers to navigating and implementing value-based payment models that the AAFP and Humana survey identified two years ago are still prevalent. The majority of respondents (86 percent) cite investment in health IT as a barrier to value-based pay implementation, the same as in 2015 (87 percent). Ninety percent of respondents identified lack of staff time as a barrier; 62 percent cited lack of evidence that using performance measures results in better patient care; 78 percent identified lack of transparency between payers and providers, and 78 percent cited lack of standardization of performance measures.

Other barriers that respondents identified include insufficient training on advance care delivery functions (64 percent), lack of timely data to improve care and reduce costs (70 percent), no uniform insurance company reports on performance (75 percent), and ability to understand the complexity of financial risk (75 percent).

The survey results also indicate interoperability is improving, if slightly: 73 percent say it’s a barrier today, versus 76 percent two years ago. Also, in 2015, 81 percent cited a lack of resources to report, validate and use of data, while that dropped to 74 percent in this latest survey.

Additionally, only 8 percent of family physicians agree with the statement “quality expectations are easy to meet in VBP models,” down from 13 percent in 2015.

“Family physicians are doing the work to prepare for value-based care models,” AAFP president Michael Munger, M.D., said in a statement. “Our members are making changes at the practice level and making investments to prepare for the transition to value-based models that will support better care. However, major barriers still exist that are stifling progress. Among the most commonly noted are issues related to administrative burden like a lack of staff time, lack of standardization for reporting requirements and lack of data transparency.”

Roy A. Beveridge, M.D., Humana’s chief medical officer, said in a statement, “While the study shows that more family physicians have adopted value-based payments, there’s not much change in the way they see this model of care influencing what they care most about – their patients’ health, or their staffs’ morale and their practices’ performance.” He added that Humana is using these findings to create even greater urgency for its simplification efforts, including standardizing quality measures and reducing the number of them as well as increasing collaboration and transparency in sharing data and actionable insights.