Value-Based Care: Gaining Ground or Losing Steam?

Healthcare executives are focused on advancing value-based care, and a new survey helped identify some of the barriers they face on that journey, as well as offer a blueprint for how to overcome them.

According to a Quest Diagnostics-commissioned value-based care survey, little progress has been made toward achieving value-based care since last year, and we may even have lost ground.

In total, 451 respondents participated in the survey. Of these, 300 were primary care physicians employed in a private practice but who have an affiliation with a hospital and 151 were health plan executives (director-level and above).

“The survey suggests that progress toward value-based care has stalled over the past year,” says L. Patrick James, MD, chief clinical officer, health plans and policy, medical affairs, Quest Diagnostics. “Specifically, providers believe they lack the tools and data to deliver value-based care and health plan executives are more aware of these limitations than in the past. That said, health plan executives may be out of step with the physician experience. They may not appreciate just how challenging it is for physicians to transition to value-based care given current technologies and access to data.”

There are clear areas of consensus amongst physicians and health plan executives that are good starting points, such as simplifying quality measures, optimizing existing technologies and investing in tools that improve data access and interoperability, according to James.

The survey evaluated perceptions of the value of seven IT-related technologies that are likely to influence healthcare in the future: bioinformatics, artificial intelligence, SMART app platform, FHIR (Fast Healthcare Interoperability Resources), machine learning, augmented reality, and blockchain.

“We found that physicians and health plan executives agreed bioinformatics and artificial intelligence have the most potential to improve value-based healthcare, and a slight majority said the primary advantage of blockchain in healthcare is improving interoperability,” James says.

While enhancing the “consumer experience” is widely discussed as a key aim in healthcare, it is not clear from the survey findings that those most responsible for delivering it-physicians-share this enthusiasm, according to James. In fact, a 20 percentage-point gap exists between physicians and health plan executives on the question of whether “putting more emphasis on a consumer-based approach to healthcare will help advance value-based care.”

“That said, both physicians and health plan executives cited patient engagement as highly important to care management,” he says.

Forty two percent of physicians said EHRs could help them succeed in a value-based care environment, indicating more improvements to these tools are needed.

Other key findings

• Most physicians and health plan executives still believe healthcare is fee-for-service and that value-based care progress will stall under the current administration
• Physicians are lacking the tools, data and patient information they need to succeed under value-based care
• Longstanding barriers to health information technology continue to hinder adoption, including lack of EHR interoperability
•  Health plan executives and physicians are not aligned, particularly when it comes to quality metrics and consumer-based approaches to healthcare

“If you are a health plan executive, this study suggests you need to collaborate more closely with your physicians and your technology vendors to ensure the solutions are in place to move value-based care forward,” James says. “Our study shows that health plan executives are more aware of the challenges physicians face, but there is still a large disconnect, and that may hobble this transition.”

If you are a physician, according to James, “we encourage you to work with your executive team and the health plans you collaborate with and let them know what you need. They may not be able to make it possible. But don’t assume they understand the extent of your struggles with current technologies, data and quality measures. For instance, when asked ‘How strongly do you agree that quality measures are useful in improving care quality?’ 80% of health plan executives agreed, compared to only 68% of physicians. Payers may have a rosier view of value-based care than the doctors caring for patients,” he says.