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Complexity of Quality Measures, Lack of Access to Patient Data Significant Obstacles on the Path to Value-Based Care

June 15, 2016
by Heather Landi
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Physicians and health plan executives cite the complexity of quality measures and incomplete access to patient data as the obstacles standing in the way of widespread and meaningful adoption of value-based care models, according to a study from Quest Diagnostics and Inovalon.

Regina Corso Consulting conducted an online survey of 450 respondents on behalf of Quest Diagnostic and Inovalon during a two-week period in May, and of the respondents, 300 were primary care physicians employed in private practice but with an affiliation with a hospital and 150 were health plan executives at the director level and above.

According to the study report, titled “Finding a Faster Path to Value-Based Care,” the ongoing transition in healthcare from volume- to value-based care models has not been easy, and much has been written about new burdens placed upon health plans, hospitals, accountable care organizations (ACOs) and physicians.

The aim of the study was to gauge physician and health plan executives’ perceptions about the progress toward value-based care and what challenges may be preventing rapid adoption. Value-based care refers to healthcare delivery models on which payment is based on patient outcomes, care quality, appropriate utilization and other metrics, as opposed to traditional fee-for-service.

Among the key findings of the study is that there is a consensus among physicians and health plan executives that quality measures are too complex, which makes it difficult for physicians to achieve them. In fact, 74 percent of all respondents agreed with that statement, which indicates that complexity is impeding adoption.

While three quarters of all survey respondents agreed that “quality measures are useful in improving care quality,” only half agreed that quality measures set under value-based care models are top of mind when physicians meet with patients.

“The study confirmed that the complexity of managing myriad quality scoring systems, risk adjustment models, reimbursement rules, incentives and penalties attendant to value-based care is a far more significant challenge than we realize. And it’s clear that new tools are still needed and wanted to overcome these challenges,” the study report authors stated.

"We expected see that physicians and health plan executives regard quality measures as too complex. And that’s too bad since 75 percent of physicians and health plan executives in the study agreed that quality measures are useful in improving care," Harvey Kaufman, M.D., senior medical director, Quest Diagnostics, says. "But, likely because of the complexity issue, only 50 percent agree that quality measures set under value-based care models are "top of mind" when physicians meet with patients. We expected complexity to have an impact on usage and adoption, but these numbers show that we still have more work to do."

Another key finding from the study is that respondents feel that access to patient data is critical, yet still lacking.

While close to 90 percent of all respondents said that it’s very important (26 percent) or extremely important (61 percent) to have access to all of a patient’s medical records, about two-thirds (65 percent) of physicians said they do not have all the healthcare information they need about their patients.

In addition, according to the study report, only 36 percent of physicians said they’re satisfied with the access they have to patient data within their existing workflows. Limitations to having better information include: “patients can have many physicians [who] may not share information across electronic health records (EHRs) or other channels” (78 percent), “lack of interoperability” (74 percent) and “no way to integrate into current workflow” (37 percent).

 “The study 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,” Kaufman says.

Another significant finding from the study is that physicians and health plan executives have starkly different perceptions about the importance of value-based care, as well as the impediments to value-based care adoption.

According to the survey, 57 percent of health plan executives believe the United States healthcare system should be value-based (versus fee-for-service or some other approach), compared to 33 percent of physicians.

For instance, when polled about whether it’s clear to physicians which quality measure apply to their individual patients under relevant value-based care models, health plan executives measured 17 percent higher than physicians, at 58 percent versus 41 percent. According to the study report authors, this suggests that health plan executives may not fully understand the true complexity for physicians at the point of care.

"Implementation of value-based care models is a work in progress," Kaufman says. "Increasingly, health plans, health systems and physicians are collaborating to understand what’s working and what’s not. Yes, our study shows that more health plan executives think that physicians have the tools needed to succeed in a value-based care system than physicians themselves do (44 percent vs. 29 percent), but this is likely an honest misunderstanding. The study can help align all key stakeholders around what’s really happening at the point of care."

One thing that health plan executives and physicians do agree on, according to the survey, is that new tools are needed—and wanted—at the point of care. Specifically, 64 percent of physicians and health plan executives said that physicians do not have the tools needed to succeed in a value-based care system. According to the study authors, the disparity between health plan executives and physicians is telling—44 percent of health plan executives believe that physicians have the tools needed to succeed in a value-based care system, yet only 29 percent of physicians agreed.

Again, this shows that health plan executives may not understand the extent to which physicians are hindered at the point of care, the study authors noted. “Collectively, among all respondents, nearly two-thirds said the healthcare system does not have the tools to succeed under a value-based care model.”

The survey also asked respondents if a tool exists within the physician’s workflow that is aligned with providing quality and value-based care today, and nearly half (48 percent) said no or they weren’t sure. Among those who said “yes, there definitely is,” only one third (32 percent) named “electronic health records system” or “electronic medical records system” as being that tool.

Acknowledgement that tools are lacking is important since more than four in five (88 percent) of all survey respondents agreed that such a tool would probably be useful.

The survey also found that 85 percent of physicians were likely or very likely to use a tool that provides on-demand patient-specific data to identify gaps in quality, risk and utilization as well as medical history insight within the clinical workflow in real time.

Kaufman says this particular finding is surprising. "Much has been written about physician frustration with technology, especially that it takes time away from patients. But it’s possible that what physicians really want is better technology that enhances the patient encounter and doesn’t create undue burden," he says.

Some other notable findings from the survey indicate that the healthcare system is not as far along toward value-based care as many think, as 63 percent of physicians and health plan executives believe the U.S. healthcare system is still predominantly fee-for-service. And, there was an interesting age-related difference among physicians regarding perceptions about value-based care. Younger physicians, or those practicing for less than 20 years, seemed more supportive of value-based care, as close to half (42 percent) of those physicians said we should have value-based care, compared to only 23 percent of physicians that have been practicing for more than 20 years.

And, health insurers saw room for improvement with documentation at point of care. As to whether physicians are routinely providing care that is well-documented for health plan reimbursement, 44 percent of health plan executives said that only some physicians provide this. Only slightly more than one third (38 percent) of health plan executives believed that most or all provide this. Meanwhile, 92 percent of health plan executives said that it is at least important for physicians to provide quality and value-based healthcare that is well-documented for health plan reimbursement, the study found.

"Healthcare leaders can look at the areas where health plan executives and physicians see things differently and build strategies to close those gaps. There are solutions designed to more clearly align value-based care objectives and outcomes, and now we have a clearer sense of what might still be in the way. By noting the differences in how different stakeholders perceive remaining challenges, the study highlights a possible path forward for accelerating value-based care adoption," Kaufman says.


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