Doctors, Payers Think Transition to Value-Based Care Has Slowed, Survey Says

This story has been updated.

The shift to value-based care has stalled since 2017, according to a survey of health plan executive and providers commissioned by Quest Diagnostics. Quest said its third annual study suggests that physicians need better tools, like data access, and less complex quality measures to spur adoption of value-based healthcare, which focuses on care quality and patient outcomes rather than the quantity of services delivered.

A total of 451 people—300 primary care doctors and 151 health plan executives—answered the online survey this spring.

The report, Stalled Progress on the Path to Value-Based Care, said barriers to value-based care include:

• Physicians’ lack of tools and insufficient information about their patients
• Continuing misalignment of perceptions of physicians and health plan executives, particularly regarding the usefulness of quality metrics and technology in providing patient care.

Among both physicians and health plan executives, more than two-thirds (67%) said they believe the United States has a fee-for-service (FFS) system versus a value-based care system (27%). In the 2017 study, those numbers were 63% and 29% respectively, which suggests a possible slide backwards.

Sixty-six percent of respondents believe that value based care will stall under the current administration, but 83% believe the movement towards value-based care will continue, no matter who is in office.

According to the survey results, physicians and health plan executives are much less confident that physicians have sufficient information about their patients. Nearly three-quarters (72%) of all survey respondents said physicians do not have all the information they need about their patients, up from 60% in 2017. Fifty-seven percent of payers said they believe physicians do not have the tools to succeed under value-based care, up significantly from 45% in last year’s study.

Only 39% of physicians said electronic health records (EHRs) provide all the data they need to care for their patients. Among the tools that would be helpful, besides EHRs, are clinical decision support, data analytics, and EHR plug-ins or modules.

Frustration with EHRs was also evident in that slightly more than half of all respondents said they would rather optimize existing technology than create new technology. Compatibility issues and systems that create “more work with little/no benefit” are 2 of the most common complaints, the report said.

When asked “how strongly do you agree or disagree that investments made in technology for quality initiatives have improved the value of healthcare for patients,” 80% of health plan executives agreed, compared to only 68% of physicians. Additionally, 62% of health plan executives said there has been progress toward alignment between payers and providers, but only 41% of physicians agreed.

The survey found agreement between the 2 groups on the issue of quality measures, with both saying they are too complex (74%). "The recent proposals made by CMS with respect to trimming quality measures is a step in the right direction," said Thomas Romeo, General Manager of Healthcare IT, Quanum Solutions, Quest Diagnostics, in an email exchange with The American Journal of Managed Care® (AJMC®).

Technology was another area where doctors and payers agreed upon. More than 6 in 10 of all physicians and health plan executives agreed technologies such as bioinformatics, artificial intelligence (AI), the SMART App Platform, FHIR (Fast Healthcare Interoperability Resources), and machine learning have potential to improve value-based care.

More about the role of health information technology and value-based care

Romeo elaborated on some of the ways Quest is using AI and blockchain, as well as other issues raised by the survey.

"Quest is continually exploring the potential of new technologies to deliver insights that empower better health," he said. "That’s why we’re already using AI in certain areas of Quest’s business, from genetic sequencing for cancer patients that connect to therapies and clinical trials through IBM Watson, to patient enrollment in clinical trials."

He said the survey findings indicate "that more education of physicians around the use of blockchain in healthcare is needed, particularly its potential to improve interoperability," adding, "blockchain may be one possible answer in the future with potential to enable hospitals and other providers’ systems to easily and securely share their data."

Asked how bioinformatics can improve value-based care, Romeo responded, "Academic medical centers, health systems, and community hospitals play a critical role in harnessing the power of next-generation sequencing (NGS)-generated data—proving its utility by conducting clinical trials, gathering evidence, and helping clinicians make practical use of it."

He said this will require "the development of bioinformatics infrastructures that facilitate the integration of genomic data into the EHR. Only then can the data’s true promise be realized, as clinicians are able to use it to not only diagnose, treat, monitor, and manage a variety of diseases, from the very rare genetic mutations to the more common conditions (like cancer and heart disease), but also to predict and prevent them."

Earlier this year, Quest and UnitedHealthcare agreed to a value-based care arrangement, saying they have created a “long-term strategic partnership” designed to reduce costs and provide better care. In addition, Quest will be a national in-network lab provider for all UnitedHealthcare plan participants beginning January 1, 2019.