What Is Value-Based Care? Depends on Who Is Asked

While the United States healthcare system has been slowly transitioning to value-based care from a system based on volume, a recent study found that primary care physicians and health plan executives aren’t actually on the same page. The study, jointly commissioned by Quest Diagnostics and Inovalon, discovered that primary care physicians and health plan executives had vastly different opinions on the successes of and barriers to the value-based care model.

The study surveyed 450 individuals, 300 of which were primary care physicians employed at a private practice but with an affiliation to a hospital, and the remaining participants were health plan executives at the director-level or above.

According to study results, three-fourths of the entire study group said quality measures were too complex, therefore making it difficult for physicians to achieve them. Researchers found that only half of all study participants clearly understood which quality measures applied to individual patients under a value-based care model. Within this group that agreed, more health plan executives than physicians believed these quality measures to be clear, suggesting that health plan stakeholders may not understand the true complexity for providers at the point of care.

"This study shows that physicians and health plan executives differ in their perceptions of how effectively the nation's healthcare system is progressing toward value-based care," said Harvey M. Kaufman, MD, senior medical director at Quest Diagnostics, said in a statement. "It also reveals that complexity and incomplete access to patient information may be greater obstacles to adoption than previously realized. We hope the study's findings spark greater collaboration by providers and health plans and dialogue about new solutions to improve quality outcomes and reduce overall costs."

Study researchers also discovered that patient data is still a critical but lacking detail in value-based care models. While 87% of the entire study group said that it’s very important to have access to all of a patient’s medical information, only 34% of physicians said to have had all of the healthcare information they needed for their patients. Survey responses indicated that barriers to this lack of information included patients may be seeing multiple physicians who may not share information across various electronic health systems, a lack of interoperability, and the idea that there is no proposed solution to changing the current workflow.

Among the study’s many findings, researchers found a disparity in how well health plan executives believe the value-based system to be working in comparison to the primary care physician’s responses. Only 33% of physicians believed the US healthcare system should be value-based, as compared to 57% of health plan executives. However, both groups predominantly agreed that they did not see a change in the healthcare system—63% of respondents said that they view the healthcare system as still fee-for-service.

“By noting the differences in how these challenges are perceived, the findings highlight a possible path forward accelerating value-based care adoption so that all stakeholders, from health plans and health systems to physicians, can clearly see the benefits of value-based care and have the right tools in place to meet the needs of their patient populations,” the authors wrote in the report.

While the study highlights significant differences in the opinions of the transitioning value-based system from both practicing primary care physicians and health plan executives, the authors noted that he study was important in helping to discover which challenges still stand in the way on both ends of the healthcare spectrum.