Physicians Need Help with Details, Data Management in New Value-Based Payment Models: Study

As value-based healthcare payment models continue to surge, physician practices need help managing increasing amounts of data and responding to the diversity of programs and quality metrics from different payors, according to a new joint study by the RAND Corporation and the American Medical Association (AMA).

The alternative healthcare payment models include episode-based and bundled payments, shared savings, pay-for-performance, capitation and retainer-based practices, accountable care organizations (ACOs) and patient-centered medical homes (PCMHs) all intended to improve quality and reduce costs.

Many physician practices are responding by partnering or merging with other medical practices or hospitals in order to better support the investments necessary to succeed in new payment models, such as care managers and information technology, according to researchers. Practices say that realigning their operations to the goals of the new payment strategies can be challenging when necessary data are not available or different payment models conflict with each other.

Researchers performed case studies of 34 physician practices in six diverse geographic markets to determine the effects that alternative healthcare payment models have on physicians and medical practices in the United States.

Key findings of the study include the following:

  • Among the practices surveyed, none had experienced financial hardship as a result of involvement in new payment models.
  • Physicians generally agreed the transition encouraged collaborative team-based care to prevent the progression of disease, and increased access to care and physicians through telehealth or community-based care.
  • Physicians were supportive of new patient registries that list patients with certain health conditions as a way to improve care. But they had concerns about documentation requirements where the link to better care was less clear.
  • The operational details of alternative payment models can either help or hinder practices’ efforts to improve their own processes. For example, practices are investing significantly in information systems to analyze large amounts of data about practice patterns. But when crucial data (like quality performance feedback and drug prices) are missing or inaccurate, it is difficult for physician practices to use data analysis to improve care and reduce spending.
  • While physician practices are making substantial investments in data collection, payors also should consider investing in the capability of physician practices to manage the information. Such investments could enhance the effectiveness of new payment models, and help medical practices make the best use of computerized health records and other health information technology, according to researchers.
  • In addition, payors should consider ways to harmonize key components of alternative payment models, especially performance measures. Medical practices usually contract with many payors, who each may have different performance measures tied to payment rewards. So medical practices must cope with how to address hundreds of performance measures and create a coherent response.

Researchers also found that most medical practices have shielded individual physicians from direct exposure to the new financial incentives created by payors. While practices are paid more for improved performance, practices generally use nonmonetary incentives to encourage physicians to change their decision-making. Those methods include efforts such as providing performance feedback to individual doctors and are intended in many cases to appeal to physicians’ sense of professionalism.

The study found alternative payment models generally have not changed the core content of physicians’ clinical work. Efforts to improve efficiency by delegating some tasks to non-physicians had the unintended consequence of increasing the intensity of physicians’ work, raising concerns about burnout.

Source: RAND Corporation March 12, 2015

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