The move to value-based care, and away from fee-for-service models, began in 2008 with the launch of the Medicare Improvement for Patients & Providers Act (MIPPA). With the Affordable Care Act (ACA) of 2010, a number of new programs entered the value-based care picture. There continue to be several challenges in value-based care, particularly for new independent practices. A number of recent surveys have revealed the biggest physician barriers to value-based care.
The Centers for Medicare & Medicaid Services (CMS) states that value-based programs reward health care providers with incentive payments for the quality of care they give to individuals with Medicare. Significant programs designed to move independent physicians toward value-based care have included:
- The Medicare Access & CHIP Reauthorization Act of 2015 (MACRA)
- Alternative Payment Methods (APMs)
- Merit-Based Incentive Programs (MIPS)
- 21st Century Cures Act
Several physician barriers to value-based care have been identified by healthcare professionals participating in surveys designed to learn more about the mixed spending and quality results seen in the program.
Although about half of the participants in one survey saw fewer medical errors as one of the biggest benefits, about a fourth of the healthcare leaders said that a lack of resources, such as staffing and healthcare IT software, was the biggest barrier to implementing value-based care.
During August 2019, over 1,000 healthcare leaders were asked about the value-based care landscape. Their responses pointed to some of the biggest physician barriers to value-based care, which included:
- Changing regulations/policies: The shift from fee-for-service healthcare to value-based care has been underway since the passing of MIPPA in 2008. Since that time, CMS has been introducing and modifying value-based incentive programs.
- Trouble with collecting and reporting patient information (i.e.: gaps in care): If patient data is inaccessible to providers, it is essentially useless in terms of care coordination and preventative medicine.
- Unpredictability of revenue stream and complexity of financial risk: Respondents said that one of the biggest barriers to adoption of value-based payments, in terms of practice sustainability, was the unpredictability of revenue stream and the difficulty understanding the complexity of financial risk involved in these programs.
- Lack of resources (short-staffed, insufficient healthcare IT software, etc.): Physicians are challenged by staffing shortages and indicate they may need to learn how to capitalize on rising opportunities such as implementing health IT systems to handle population health initiatives.
- Gaps in interoperability, internally and externally: Interoperability continues to be a challenge for providers. Value-based care requires an unprecedented amount of healthcare data exchange and analytics, so adopting technology solutions like interoperable EHR systems, patient and provider engagement technologies (like telehealth technologies), and core operational and financial applications are critical to moving forward with value-based care.
These survey participants were also asked, “What factors do you believe would accelerate the adoption of value-based care?”
- Appropriate provider compensation and incentives: The participants cited provider compensation and incentives as the best way to accelerate the adoption of value-based care. Under the current system, providers can opt into value-based purchasing initiatives, receiving bonuses for performing above average and being penalized for performing below average. However, more clarity may be needed to entice providers to participate in value-based care programs.
- Policy requirements: Policy appears to be an accelerating factor. CMS continues to encourage value-based care reimbursement, but it may need to continue ramping up efforts for providers through policy changes and updates.
- An increase in risk-sharing models like accountable care organizations (ACOs): Providers see a slight benefit to increasing risk-sharing models. Full financial risk sharing in healthcare may not be widely adopted yet; however, evidence shows that the greater level of financial risk sharing, the greater the care quality and costs benefits.
- Consolidating market, mergers and acquisitions, moving more providers into the value-based care model: Industry consolidation appears to be accelerating the implementation of value-based care programs. The past few years have seen the highest level of healthcare provider consolidation in U.S. history with the number of ACOs growing consistently.