What’s Trending: Alignment and Advanced Practice Infrastructure Are Key for Success in Value-Based Primary Care
While value-based care has become a well-recognized way to align economic interests with activities that should improve patient outcomes and reduce unnecessary spending, ensuring that physicians can deliver against a value-based care mandate is another matter.
Despite the proliferation of activity, existing research is hazy at best in answering critical questions around characteristics, behavior, and infrastructure of established and aspiring value-based practices. To capture what enables primary care providers to deliver against their mandate, we conducted a national survey of over 300 primary care physicians (PCPs) across the United States to shine light on current practices and anticipated trends in the value-based care space.
WHY IT MATTERS:
In our national value-based care survey, we analyzed and segmented the PCP landscape into 3 cohorts to understand how the degree of alignment to value-based care affects their practice, decision-making, and competencies.
- Value-Based Care Leaders: 21% of PCPs report having one or both of partial- or full-risk capitation agreements in their practice.
- Value-Based Care Experimenters: 48% of PCPs acknowledge having another value-based agreement, such as participating in accountable care organizations (ACOs), clinically integrated networks (CINs), shared savings, or bundled payment agreements.
- Value-Based Care Abstainers: The remaining 31% of PCPs reported not participating in any of these agreements or were unaware of the agreements they had altogether. Our assumption for this analysis was that physicians who are unaware of their value-based contracts are not positioned to manage any specific value-based contracting outcome.
Key findings from the analysis include:
While value-based care models are prevalent, those that involve explicit risk-taking are less so.
- 69% of PCPs participate in some value-based care model, with 21% in a form of capitation.
- 40% of PCPs report taking financial risk on their patients. Among those PCPs, 24% of the patients on their panel are at financial risk.
- 20% of physicians didn’t know whether their practice was engaged in a value-based care payment model, highlighting the significance of shared goals and clear communication between clinicians and those at the executive level.
PCPs who are more aligned to value-based care have more advanced practice infrastructure to support them, with a clear distinction among cohorts.
- 71% of PCPs surveyed believe their capabilities required to deliver on value-based care will improve over the next 5 years, but practices will have to be intentional in their plans to adopt value-based care models.
- Across the board, Leaders have a higher prevalence of capabilities that support managing risk in value-based care arrangements. For instance, 32% of Leaders have reporting on patient-level utilization/spend, compared to just 9% of Abstainers.
- Leaders utilize APPs the most, with an APP-to-PCP ratio at 1:2, as compared to 1:3 among Abstainers.
PCP workload, time allocation, and satisfaction are affected by the level of alignment to value-based care.
- 41% of Experimenters report experiencing burnout (compared to 28% of Leaders and 28% of Abstainers), likely stemming from the fact that they have made a commitment to managing value-based care contracts but have not invested in the required infrastructure that will improve their experience doing so.
- Leaders work an average of 48 hours per week—3 hours fewer than Abstainers.
WHAT'S NEXT:
Healthcare organizations looking to participate in value-based care must do so meaningfully and with intention, or they risk being ineffective and eroding the professional satisfaction of their PCPs as a result.
Commensurate with a commitment to value-based care is the mandate to invest in the capabilities required to deliver on it. Capabilities include notification or reporting on care outside of the practice, adjacent or on-site clinical services, and support tools for risk identification and stratification, among others.
Additionally, as the presence of value-based primary care continues to expand, the Leader archetype will be increasingly favored. Accordingly, Experimenters and Abstainers have an opportunity to align the characteristics of their practices more closely to those of Leaders in this high-growth sector. And the evidence seems to support that greater infrastructure at value-aligned practices translates to reduced workload and improved job satisfaction.
When executed well, the expansion of value-based care can improve quality of care, decrease spending, and increase satisfaction among patients and providers alike. But the key will be ensuring appropriate communication, alignment, and advanced practice capabilities that enable physicians to successfully practice in this environment.
