While there continues to be progress towards increased adoption of value-based care and payment models, the pace has been slowed by poor alignment between health plans and providers, as well as providers lacking the right tools to close critical gaps in healthcare, according to a new study by Quest Diagnostics and Inovalon.
Laboratory services company Quest and analytics solutions provider Inovalon conducted a survey of 452 primary care physicians and health plan executives to gauge their perceptions about the healthcare industry’s journey from fee-for-service to value-based care and to examine how providers and payers align and diverge in their view of the obstacles and opportunities ahead.
The 2017 study, titled “Progress on the Path to Value-Based Care,” is the second annual study commissioned by Quest and Inovalon. The study findings indicate health information technology, such as electronic health records (EHRs), are still not bridging many critical gaps. The study points to opportunity for further alignment between health plans and providers to advance value-based care, including extending the capabilities of EHRs and co-investment by providers and health plans in health IT.
The study found that despite agreement among leading stakeholders that value-based care models can improve healthcare, most physicians and health plan executives surveyed said that fee-for-service still dominates. Only 29 percent of physicians and health plan executives said they believe healthcare in the United States is value based, and this was a marginal increase from the findings in the 2016 study.
The findings also indicate that a majority of individuals at the point of care believe much of healthcare is behind the adoption curve. Years in practice appear to influence this perception, with physicians surveyed who have been in practice two decades or longer more likely to believe fee-for-service dominates healthcare than those in practice fewer years. Specifically, 31 percent of physicians who have been practicing 20 years or less believe the U.S. has a value-based healthcare system, while only 16 percent of physicians who have been practicing 21 years or more agree.
However, there is a silver lining as most physicians and health plan executives believe the transition to value-based care will continue regardless of efforts in Washington to repeal and replace the Affordable Care Act. More than eight in 10 of those surveyed (82 percent) said they believe the transition to vale-based care will continue, regardless of legislative reforms spearheaded by the federal government.
Health plan executives and physicians agreed (83 percent of all surveyed) that alignment between payers and providers is more important than ever to provide value-based care. However, the findings also strongly suggest that there is more work to be done to improve payer-provider alignment. According to the survey, seven in 10 health plan executives (70 percent) said progress has been made to better align health plans and providers in healthcare. But, less than half of physicians (47 percent) agreed.
A key insight from the study is the perception that tools are still lacking to support value-based care, and the study findings also indicate significant misalignment between health plan executives’ and providers’ perceptions of the availability of these tools. About half of payer executives (53 percent) said physicians have the tools they need to succeed in a value-based healthcare system, while only 43 percent of physicians agreed with this, a gap of 10 percentage points. However, the gap is smaller than in last year’s study, which saw a gap of 15 percentage points. This suggests progress toward alignment.
Additionally, in the 2016 study, only 29 percent of physicians said they had the tools to succeed under value-based care, so the increase to 43 percent this year represents a 14-percentage-point increase year-over-year. Further, the percentage of health plan executives agreeing with that statement increased nine percentages points from last year's findings to this year.
Drilling down into health IT, the study findings also indicate there is a difference in perception among health plan executives and physicians regarding the value of EHRs. Three-fourths of health plan executives (75 percent) said EHRs have everything physicians need, however, only about half of physicians (54 percent) agreed. What’s more 70 percent of physicians said they do not see a clear link between their EHRs and better patient outcomes.
While the study findings indicate that EHRs may not be closing gaps, physicians believe that extending their capabilities could unleash value. Seventy-seven percent of physicians investing in health IT also invest in EHRs, and 71 percent of physicians said they would be willing to spend more time with their EHR if the technology could yield insights unique to their patients. Moreover, nearly nine of 10 physicians (85 percent) agreed that access to quality/performance measures specific to patients is key to achieving value-based care.
Additionally, 65 percent of physicians also indicated that if they could get one key insight at the point of care it would be information related to performance or quality measures that apply to their individual patients.
“Taken together, these findings suggest EHRs could provide an avenue for physicians to actively seek out information to aid quality and performance measurement reporting. Imbuing current EHR offerings with this type of data could potentially extend their value,” the study authors wrote.
Looking at accelerating progress towards value-based care, the study suggests that co-investment in health IT may be key. New investment is needed to close gaps and align payers and providers, according to the study. Eighty-five percent of health plan executives said co-investment by health plans and providers in health IT would accelerate value-based care adoption.
“This finding supports other research that shows health plans experience greater benefits from the implementation of information technologies, such as EHRs, than the providers that implement them. Perhaps health plan executives are mindful of the significant investment required of physician practices to implement HIT solutions and the potential for co-investment to help surmount this challenge,” the study authors wrote.
Health plan executives’ interest in co-investment may be related to enhancing patient care—77 percent said investments made in technology for quality initiatives have improved the value of healthcare for patients, the study found.
Overall, when comparing the study findings from 2016 to 2017, it appears that progress is being made. The percentage of physicians and payers who agree that the U.S. healthcare system is value-based grew 4 percentage points, while the percentage who think physicians have the tools to succeed in a value-based healthcare system grew 12 percentage points. The percentage of physicians who said they do not have all the information they need about their patients decreased by 3 percentage points.
“Our study supports the widely-accepted notion that data and technology are critical to the success of value-based care. But is also indicates that more needs to be done to make data actionable, accessible and patient-specific, particularly for physicians,” L. Patrick James, M.D., chief clinical officer for health plans and policy, medical affairs, Quest Diagnostics, said in a statement. “One of the study’s most striking findings is that physicians question the value of EHRs, but they’d be willing to spend more time with them if they could ultimately gain patient-specific insights in real-time.”