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Value-Based Care Shift Has Halted, Study Finds

July 17, 2018
by Rajiv Leventhal
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More than two-thirds of respondents said they believe the U.S. has a fee-for-service system versus a value-based care system

A new study of 451 physicians and health plan executives suggests that progress toward value-based care has stalled. In fact, it may have even taken a step backward over the past year, the research revealed.

The study, commissioned by Quest Diagnostics, points to physicians' lack of tools and insufficient information about their patients as possible reasons for the value-based care slowdown. Other barriers include continuing misalignment of perceptions of physicians and health plan executives, particularly regarding the usefulness of quality metrics and technology in providing patient care, according to the research.

The study, “"Stalled Progress on the Path to Value-Based Care," is the third annual study from Quest Diagnostics to gauge perceptions of physicians and health plan executives about the nation's journey to value-based healthcare, which focuses on care quality and patient outcomes rather than the quantity of services delivered. Some of the study’s specific key findings include:

  • Physicians and health plan executives agreed that healthcare has made little progress toward value-based care since last year, and may even have lost ground. Among both physicians and health plan executives, more than two-thirds (67 percent) said they believe the U.S. has a fee-for-service system versus a value-based care system (27 percent). In last year's study, those numbers were 63 and 29 percent respectively, which suggests a perception that the healthcare industry has taken a step backward toward fee-for-service, researchers noted.
  • The majority of health plan executives said they now believe physicians do not have the tools to succeed under value-based care, a significant shift from last year when the majority said physicians had the tools. Fifty-seven percent of health plan executives agreed that physicians do not have the tools to succeed under value-based care, an increase of 12 percentage points from 45 percent in the 2017 study.
  • Both physicians and health plan executives are much less confident that physicians have sufficient information about their patients. Nearly three-quarters (72 percent) of all survey respondents said physicians do not have all the information they need about their patients, an increase of 12 percentage points from the 2017 study. Additionally, only 39 percent of physicians said electronic health records (EHRs) provide all the data they need to care for their patients.

The government has made clear its intention to make the shift to value-based care one of its core healthcare priorities, but studies of late have raised questions about just how quickly things are moving. For instance, a Change Healthcare survey of 120 healthcare payers reported that nearly two-thirds of payments are now based on value, while “pure” fee-for-service is fading. On the other hand, an Healthcare Financial Management Association (HFMA)-led analysis disclosed that value-based payment models have not yet shown a reduction of the total cost of care or improvement in clinical quality outcomes at the market level.

What’s more, the Quest study revealed that physicians and health plan executives are not aligned, particularly around quality metrics and technology. Eighty percent of health plan executives agreed with the statement that that investments made in technology for quality initiatives have improved the value of healthcare for patients, compared to only 68 percent of physicians— a 12-point delta. Additionally, 62 percent of health plan executives believe they have made progress toward alignment between payers and providers, but only 41 percent of physicians agreed.

Further, the research found that technologies such as bioinformatics, artificial intelligence (AI) and blockchain could be key to improving value-based care. More than six in 10 of all physicians and health plan executives agreed that technologies such as bioinformatics, artificial intelligence, the SMART App Platform, FHIR (Fast Healthcare Interoperability Resources) and machine learning have potential to improve value-based care. Almost two-thirds (64 percent) of health plan executives said one advantage of blockchain in healthcare is that it can promote shared data across organizations to surmount interoperability.

"While our study suggests the healthcare industry still has a long way to go to deliver value-based care, it reveals avenues to speed the journey," L. Patrick James, M.D., chief clinical officer, health plans and policy, medical affairs, Quest Diagnostics, said in a statement. "Measures that optimize EHRs, make data more accessible and insightful and reduce complexity of quality measurement are much needed steps to accelerate this transition. First, however, it's clear that health plan executives and physicians need to better align around a shared vision of how technology and data can improve patient care." 

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