Involving physicians in value-based care decisions: The only path to lasting change

November 8th, 2017 / By Steve Delaronde

Patient engagement is widely accepted as a key condition for achieving positive healthcare outcomes. Patients who participate in their healthcare decisions and feel capable of improving their health through diet, exercise, and self-management of their conditions have better health outcomes than those who are not engaged. This engagement model has broad application and must be extended to the physicians that treat these patients if payers and providers are to achieve successful and long-lasting value-based care arrangements.

Physicians need to be engaged with their organizations and healthcare systems to achieve the quality improvement and cost savings that are the foundation of the Triple Aim. This is particularly important as health systems are embracing new payment structures, such as value-based care models. Physicians should have a roll in the design of new payment programs, as well as the identification of meaningful outcomes that they would like for their patients. Unfortunately, many physicians feel excluded from the decision-making process to adopt new payment structures. A recent survey of 980 physicians across 8 specialties revealed that 70 percent prefer a fee-for-service model, even though it is more expensive.

The acceleration towards the purchase of physician practices by hospitals means that more physicians are employees rather than owners of their practices. Fewer than half of physicians own their own practice, and since younger physicians are more than three times more likely to be employed by hospitals than older physicians, the trend is likely to continue. This gives healthcare systems leverage when implementing value-based care models and shared savings with physicians, but it also gives them responsibility to ensure that physicians feel engaged.

Although hospital-led ACOs predominate and comprise 60 percent of all Medicare ACOs, physician-led models have been growing. Additionally, physician-led models are more likely to be successful in meeting cost and quality goals than hospital-led programs. This may not be surprising given that physicians do not feel the financial impact of reductions in hospital admissions, emergency room visits, or shifts to outpatient care that negatively affects the bottom line of hospitals in a fee-for-service system. However, another key feature of physician-led programs is that physicians are more likely to be invested in these arrangements through decision-making and greater control and benefit from cost savings.

Alignment between a health system and its physicians, whether employed or affiliated, is not easy. Health system executives need to identify key physician partners based on their standing among their peers and patients. Understanding the practice patterns of these physicians through data analysis will also give insight into how well a physician partner is aligned with the goals of value-based care. This can be done through an analysis of risk-adjusted data across a patient’s entire continuum of care to understand overall cost and quality outcomes and the physician’s role in these.

Once key physician partners are identified, incentives must be developed that are aligned across multiple physician specialties, not just primary care providers. Compensation is clearly an important incentive, but it is not the only one. Recognition of a physician’s contribution towards positive clinical outcomes and collaborative care will resonate with many physicians. Creating a mechanism to share positive results and increase transparency will incent high performing physicians to share their methods and best practices.

The best way to align any individual or group with the goals of an organization is to give them a voice in developing, participating and benefiting from the structure. Just as engaged patients experience better health outcomes, engaged physicians will be more likely to support and achieve success in a value-based payment model that they have helped design.

Steve Delaronde is director of analytics for populations and payment solutions at 3M Health Information Systems.


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