Fifty-four percent of family physicians (FPs) who provide patient care say that their practices participate in value-based payment (VBP) models, and half believe that these models will encourage greater collaboration between primary care physicians and specialists, according to a survey sponsored by Humana and conducted by the American Academy of Family Physicians (AAFP).
However, many physicians still don’t understand the concept of VBP. Sixty percent of the respondents said they were very or somewhat familiar with VBP, which rewards providers who deliver high-quality care efficiently. This was only a few points higher than the percentage of family doctors who knew about VBP in 2015, when the last AAFP/Humana survey was conducted. Seven percent of the FPs said they were “not at all familiar” with VBP, down from 12% in 2015.
Family doctors as a whole remained skeptical about VBP. Sixty-two percent, the same as in 2015, said there was a lack of evidence that using performance measures results in better patient care. And 58% of respondents, just slightly less than in 2015, believed that VBP would increase work for physicians without benefiting patients.
The current status or strategy of FPs with regard to VBP has also not changed much in the past 2 years. Forty-seven percent of respondents said their practices are actively pursuing VBP opportunities, vs 44% in 2015. Twenty-one percent of the FPs said their practices have developed VBP capabilities but are taking a wait-and-see position, compared to 23% 2 years earlier. And 19% said their groups are holding off on VBP and are focused on optimizing fee-for-service income, a slight decline from the 23% who espoused that strategy in 2015.
Thirty-seven percent of respondents said they received VBP on the basis of quality measures, a big jump from the 18% of FPs who said were paid that way in 2015. Nineteen percent of respondents said their VBPs were funneled through the group or health system administration, vs 26% in 2015. Ten percent reported a mixed model of direct payments and payments through the administration, compared to 5% in 2015. About a third didn’t know how they were paid for delivering value.
Asked why their practices did not have a VBP strategy, 9% of respondents said there was insufficient evidence to support this model, compared to 17% in 2015. Thirty-three percent said they were too busy and overwhelmed to think ahead, vs 21% 2 years earlier. Eighteen percent said VBP is too risky, up from 7% in 2015.
Technology Hurdles
Notably, the practice change most often associated with preparing for VBP involved health information technology (IT). According to the survey, 54% of FPs, the same as 2 years earlier, said their practices were updating or adding health IT infrastructure for data management and analysis for VBP. Thirty-two percent of the FPs reported that their practices provided ongoing care management to high-risk patients, vs 23% in 2015. Forty-three percent said their practices had hired care managers and care coordinators, compared to 33% in 2015.
The barriers to pursuing VBP, besides those listed above, include the following:
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lack of staff time (90% vs 91% in 2015)
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investment in health IT required (86% vs 87%)
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lack of resources to report, validate, and use data (74% vs 81%)
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insufficient training on advanced care delivery functions (64% vs 72%)
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lack of transparency between payers and providers (78% vs 77%)
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lack of interoperability between types of healthcare providers (73% vs 76%)
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lack of information on cost of services provided for appropriate referrals (73% vs 76%)
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absence of uniform insurance company reports on performance (75% vs 75%)
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lack of standardization of performance measures (78% vs 74%)
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lack of timely data to improve care and reduce costs (70% vs 63%)
Commenting on the survey findings, AAFP President Mike Mungers, MD, said, “Family physicians are doing the work to prepare for value-based care models. 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.”
The 2017 VBP study was sent to 5000 AAFP members. A total of 482 surveys were returned, of which 386 were evaluated after a screening process. The researchers acknowledged that their findings “are subject to some nonrespondent error.”
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