In March 2021, Aledade worked collaboratively with the Oregon Academy of Family Physicians (OAFP) to conduct a survey designed to gauge the current understanding and perceptions of value-based care among OAFP’s family physician members.
Value-based care is defined by the Centers for Medicare and Medicaid Services (CMS) as a reimbursement model that ties payments for care delivery to the quality of care provided, as opposed to the more traditional fee-for-service reimbursement model, in which physicians are paid for rendering services based on bill charges or annual fee schedules. The national healthcare system is increasingly transitioning toward this model due to its focus on improved care delivery, improved patient outcomes, and reduced costs of care.
The survey results reveal that a majority of family physician respondents believe value-based care yields both health benefits to patients and financial benefits to practices, especially among those seeking to maintain their status as independent primary care physicians.
OAFP physicians understand the value-based care model and recognize its benefits.
The larger majority of OAFP physician members (nearly 52 percent) define value-based care as quality-driven care guided by patient preference that yields compensation for health promotion, chronic illness management, and disease prevention. These respondents describe a clear focus on patient health and outcomes in practices that have made the transition to value-based care.
A clear majority (31.3 percent) of OAFP physician members recognize that value-based care yields improved patient care, and nearly 27 percent identify improved primary care compensation as a benefit of value-based care.
This clear understanding of the model and its benefits aligns with the national movement toward value-based transformation, as represented by a 2019 APM Measurement Effort study conducted by the Health Care Payment Learning & Action Network, which found that Alternative Payment Models (APMs) are becoming the norm in the U.S. The study showed that only 39 percent of physicians remain in a traditional fee-for-service model with no link to quality and value, with the remaining 61 percent delivering care in models with at least a partial tie to quality and value.
Although value-based care is centered on putting the needs of the patient first, OAFP physicians are concerned about the perceived complexity of the transition.
Approximately one-third (28.9 percent) of respondents believe that patient well-being should be the guiding priority of the independent primary care practice, while a fifth (20.48 percent) describe “independence” as being able to make their own clinical decisions about patient care, how many patients to see and maintaining staff.
While OAFP’s physicians are strong proponents of autonomy in their practices, however, they are also concerned about the perceived risks of making the transition to value-based care. One quarter of respondents believe that changing the current system of care is the most pressing risk to the value-based care transition, followed closely by the perceived complexity of the transition (22.89 percent) and financial risk and investment (18.07 percent).
Slightly more than 13 percent believe the transition is made riskier by uncontrollable patient outcomes. Other perceived risk factors include bureaucracy (10.8 percent), interference (8.4 percent), and data (7.23 percent).
Their concerns are reflected by the results of a 2019 Definitive Healthcare survey in which 25 percent of physicians cited staffing shortages, insufficient healthcare software and other limited resources as the biggest barriers to value-based care. As a result of these perceived challenges, the numbers of independent physicians have steadily declined, with the American Medical Association reporting that 2018 was the first year in which there were fewer physician practice owners (45.9 percent) than employee physicians (47.4 percent) as practice ownership shifts away from private to hospital-owned.
Most OAFP physicians are practicing the tenets of the quality-driven model, though many are struggling to balance their quality reporting obligations.
The value-based care model is centered around preventive care, with Annual Wellness Visits (AWVs) and Transitional Care Management (TCM) as its core tenets. The survey reveals that 78 percent of OAFP physicians are completing AWVs for their patients, and 68 percent are completing TCM activities. However, nearly 15 percent and 20 percent, respectively, are completing neither AWVs nor TCMs, and 12 percent are unsure if they are completing TCMs.
However, only 33 percent of physician respondents have a complete understanding of Hierarchical Category (HCC) risk scoring. Nearly 23 percent indicate no understanding of HCC at all, while 42.2 percent note that while HCC risk scoring is included in their EHR, they do not believe they are proficient in HCC risk scoring.
Additionally, nearly 81 percent of respondents do not know how participation in an ACO can affect their status in regulatory initiatives like MIPS. Only 18 percent of physicians understand the relationship between ACO participation and regulatory initiatives.
Further, nearly 40 percent of respondents note that while they are managing their quality reporting obligations, the process is “painful.” Slightly more than 19 percent are unsure if they’re managing those obligations, and 26.5 percent say they are not managing them at all. Only 12 percent are easily managing those requirements now.
These trends, again, align with nationally reported data from the AAFP indicating that 60 percent of family physicians have contracts with seven or more payers and are responsible for reporting different quality measures to each payer. The AAFP data reveals that the average medical practice, per physician, spends an average of 758 hours per year submitting quality measures – a process that could be alleviated by value-based care adoption, which increases physician access to timely, actionable patient data.
While most OAFP physicians have access to care gap data, other information – including utilization patterns and socioeconomic factors – are less accessible.
Care gaps is currently the most accessible population health data element for the majority (51.8 percent) of survey respondents, followed by recent hospitalization data (44.58 percent) and patient demographics (38.55 percent).
Physicians indicate that specialist information (24.1 percent), utilization patterns (19.28 percent), and PCP interactions and socioeconomic factors (14.46 percent) are less accessible.
The transition to value-based care, which empowers physicians with patient data at the point of care, yields an opportunity to improve patient outcomes and reduce costs of care, according to a 2020 research study published by the National Institutes of Health, which found that organizations achieved better outcomes while often lowering costs by implementing a framework centered on identifying and understanding a segment of patients whose health and circumstances result in a consistent set of needs.
Value-based care represents an unparalleled opportunity for independent physician practices to significantly increase their income while delivering care the way they want. While value-based care has demonstrated clear benefits to physicians participating in the model, the transition can be intimidating for those unfamiliar with the transformation process and unclear about the tenets of the model. However, with the right support and an actionable roadmap for success that centers on promoting both the short- and long-term benefits of the value-based care transformation, primary practices can thrive financially by providing more proactive care for patients.
About the Survey and Respondents:
Survey responses were collected through April 2021 and tabulated and jointly reviewed by OAFP and Aledade in May 2021. Respondents included physicians in independent primary care practices (33.7 percent), hospital-owned practices (28.9 percent), Federally Qualified Health Centers (FQHCs) and Community Health Centers (CHCs) (16.9 percent), residency-owned practices (8.4 percent), Rural Health Clinics (RHCs) (3.6 percent), and teaching health centers (3.6 percent). Practice sizes ranged from greater than 50 physicians (20.5 percent) to solo practitioners (4.8 percent). More than 95 percent of respondents indicate they are currently using an Electronic Health Record (EHR) system, with the majority of respondents (57.18 percent) using an EPIC system. Slightly less than half of respondents (48.19 percent) have participated in CPC Classic or CPC+. More than 37 percent of respondents have been in an ACO, and of those, 15.66 percent indicated they do not know much about ACO work.