Contributor: Tackling Clinician Capacity Shortages in Value-Based Care

Over the past decade, value-based care programs have experienced rapid growth. Although some have successfully improved quality or reduced costs, none have achieved widespread adoption across payers, providers, and patients, let alone throughout various care journeys. There is a significant opportunity to scale the benefits of these programs to reach a broader patient population. In the first article of this series, we identified 4 main challenges that health care organizations need to tackle to deliver effective value-based care at scale: (i) the missing patient; (ii) the quality illusion; (iii) the capacity shortage, and (iv) the complexity concern. In this article, we’ll take a deeper look at the capacity shortage.

The clinician shortage has reached a new level of urgency as we face rising demand. The US has reached an inflection point when it comes to primary care. Today we face an estimated shortage of nearly 22,000 primary care physicians—a shortage that is expected to expand to 34,000 by 2035, according to HRSA. This poses an existential threat to value-based care (VBC) because today’s models define populations based on primary care physician attribution and are primarily predicated on their ability to influence and manage a patient’s care.

Providers often hold skeptical views of VBC—due in part to the increase in job demands associated with these models. They are tasked with increased mandatory activities—such as quality reporting, risk assessment, and data reconciliation—as well as new voluntary activities that are needed to help them succeed, such as care management. These new activities have resulted in an increase in administrative complexity for providers, driving to burnout and increasing costs of care as providers now must cover overhead costs for new positions in coding, care management, risk adjustment, and more.

Ajay Mody | Image credit: GCI Health

In this context, the industry has increasingly looked to advanced practice providers (APPs)—such as physician assistants and nurse practitioners—to share the burden of administering primary care. However, increasing demand for APPs has resulted in rising costs associated with care delivered by these providers—a challenge for VBC, which aims to improve costs to patients as well as quality of care.

Faced with the challenge that most organizations will not be able to ‘staff’ their way out of the workforce shortage, many will need to turn to technology for a potential solution. The technology available to providers has incredible promise to improve efficiency, expand access to clinical resources, and minimize the repetitive tasks that contribute to provider burnout. Recent developments—such as generative AI—spark even more hope that our next generation of physicians will be enabled to practice with an AI co-pilot that has encyclopedic knowledge of medical literature, leading clinical practices and patient preferences. Virtual clinical staffing is also increasingly becoming an attractive option for low-touch clinical services.

However, technology’s ability to expand physicians’ capacity can be limited by ‘clunky’ rollouts that do not consider how existing workflows will need to change in response to the new technology or the training needed to enable clinicians to use it effectively. Furthermore, many organizations today are not using the technology they have already invested in to the full extent of its capabilities—resulting in mounting ‘tech debt’ as organizations tack on additional solutions requiring integration rather than using what they already have.

The traditional care delivery model is no longer sustainable, given the demographic, workforce, and competitive challenges we face. The industry can't simply hire and train its way out of this situation. To address the capacity shortage in the long term—and deliver on the promise of lower-cost, high-quality care—we must act now to reimagine work and the workforce, use technology, and transform care delivery.

Health organizations should prioritize 3 key imperatives to tackle the capacity shortage and reinvent care delivery:

Asher Perzigian | Image credit: GCI Health

1. Revolutionize work experiences: Meeting employee needs and expectations is challenging, especially with a highly competitive clinical labor market. Health care executives must modernize workflows to rethink how technology supports our clinicians’ daily tasks, from administrative to clinical processes. Over the last 20 years, tech has been added on top of tech with little consideration to how it impacts workflows and, moreover, handoffs. Redefining the workflows associated with electronic health records (EHRs) and the end-to-end digital ecosystem will allow clinicians to spend more time on patient-facing care delivery and less time documenting, scheduling, and ordering.Streamlining these workflows can enable clinicians to work at top of license by routing administrative tasks to non-clinical staff and further drive improved patient experience.
2. Reinvent teams and work models to boost capacity: To enable value-based care, patient responsibility can't rest solely on the primary care physician. It must be shared across a multidisciplinary care team. This could involve advanced practice providers or other clinicians becoming the primary point of contact, whereas physicians are strategically involved where their expertise is most valuable. For example, the care team for a heart failure patient may include a cardiologist, primary care physician, nurse practitioner, pharmacist, dietitian, and social worker, among others. Together, this team can create a comprehensive care plan that optimizes care delivery such that the dietitian monitors sodium and fluid intake whereas the cardiologist monitors the diagnosis and treatment plan. Designing teams accordingly improves coordination, improves patient outcomes, and optimizes clinician capacity.
3. Merge technology and human ingenuity: Technology has supported health care workers for decades, but its full potential remains untapped. A model that combines data, technology, and people can reduce pressure on staff and often allows them to better serve patients. For example, incorporating technology such as remote monitoring tools and telemedicine allows clinicians to monitor patient conditions in real time, lessening demand on in-person capacity, while continuing to deliver improved outcomes and experience for patients.

Addressing the capacity shortage and transforming care delivery requires a comprehensive approach that goes beyond just adding more staff. Health care leaders must rethink how work is done, reshape care teams, and maximize technology's potential with human expertise. Together, we can cultivate a culture that welcomes continuous change and creates a more sustainable value-based care model that meets both current and future demands.

Accenture’s Florence Murabito also contributed to this article.