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Four barriers to value-based care


Study reveals growing acceptance of value-based payments among family physicians, but barriers still exist.

More family physicians are moving into value-based payment arrangements and making changes within their offices, such as hiring care management coordinators and behavioral health support, to build the necessary infrastructure.

That’s according to a study by the American Academy of Family Physicians (AAFP). But the study, sponsored by Humana, also found that physicians still face some of the same barriers to value-based payment as were identified two years previously, when a similar study was conducted, i.e., lack of enough time to fully focus on value initiatives, lack of standardized reporting among payers, and fears about risk associated with value-based payments. Nearly 400 physicians responded to the study.

Here’s more from Roy Beveridge, MD, Managed Healthcare Executive editorial advisor and Humana’s chief medical officer, on value-based payments and the barriers physicians face.

MHE: Are value-based plans becoming more commonplace? If so, why?

Beveridge: The study showed us that slightly more than half of the physicians (54%) indicated their practices participate in value-based payments. I believe we’re seeing more adoption of value-based payments for two primary reasons:

First, the industry is demanding it. Those who are paying for healthcare-the government, employers, patients, commercial health plans-want more value for their healthcare dollar. The transaction-driven, fee-for-service model has helped contribute to a fragmented healthcare system that has led to major challenges in healthcare. This fee-for-service model is simply not sustainable.  

Second, physicians are tired of being limited to treating their patients 15 minutes at a time. Physicians want to spend more time with their patients, especially those with chronic conditions, to understand their patient in total.

Physicians who are able to practice in value-based care models are seeing results- both for their patients and for their practices. At Humana, we’re distributing more payments to value-based family physicians than the national average. That’s because their Humana Medicare Advantage patients have more screenings and better health outcomes. These value-based physicians also have higher HEDIS scores, fewer inpatient admits, and fewer emergency department visits when compared to traditional fee for service.

MHE: What are some of the issues the survey identified?

Beveridge: There were many common barriers from the study but some that really caught my attention were around practice sustainability. Responses related to barriers to value-based payment implementation like:

  • Lack of staff time: 90%

  • Unpredictability of revenue stream:  77%

  • Ability to understand the complexity of financial risk:  75%

  • Lack of resources to report, validate, and use data:  74%

Then, you think that more than one-third of the physicians receive payment from more than 10 payers, you start to understand the complexity with not only payments and revenue, but data, reporting, and quality targets/goals.  It can lead to an extremely cumbersome and confusing environment for physicians and their staff to work and deliver care.

MHE: How should healthcare executives address the four barriers?

Beveridge: Healthcare executives from both care providers and health plans can begin to think outside of what has normally been a contractual relationship between the two. It’s a relationship that historically has not been collaborative and stems from negotiated rates and fee schedules. In a value-based-care environment, there are overarching, common goals between a care provider and health plan. It makes sense to work together. 

It’s only in this collaborative, open environment that we can specifically address the four barriers-time, revenue, complexity, and resources. A good starting point is with the sharing of data and insights, and that starts with the health plan. 

Certainly transparent, accurate, and timely data allows for enhanced decision making when treating patients. But it also improves practice performance, especially when a physician knows what actions and levers affect revenue and payment.

As someone who practiced medicine for more than 20 years, I can tell you, with time and resources already being a barrier, it becomes even more important for the health plan, or a vendor, to deliver data that is actionable and not cumbersome to review and understand.

Tracey Walker is content manager for Managed Healthcare Executive.


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