Humana study: Physicians warm to value-based pay models, but skepticism runs deep

From right to left, Amy Mullins of the American Academy of Family Physicians, Roy Beveridge of Humana, and Sarah Dash of the Alliance for Health Policy participate in a panel discussion on Wednesday at the Cannon House Office Building in Washington, D.C.

Though significant barriers still stand in the way of the transition to value-based reimbursement, a new study offers encouraging signs that physicians are getting more comfortable with new payment models.

The study, a joint effort between the American Academy of Family Physicians and Humana, follows up on a similar study they conducted in 2015. Representatives from both organizations—plus Health Care Transformation Task Force Executive Director Jeff Micklos—participated in a briefing Wednesday on to discuss the findings.

Amy Mullins, M.D., medical director of quality improvement for AAFP, said one of the data points that stood out the most was that 37% of those surveyed said payments based on quality measures were distributed to physicians at their practice—a “huge jump” from 2015, when it was just 18%.

Micklos also highlighted that finding, noting it’s a good sign that shared savings are trickling down to frontline doctors.

“Without that financial incentive, it’s really hard to convince a medical professional that there’s a sustainable business model there,” he said.

Mullins said it’s also promising that significantly fewer physicians said they were “not at all familiar” with the concept of value-based payments—7% in 2017 versus 12% in 2015. In addition, the study found that more practices are also hiring care management, care coordinators and behavioral health support to prepare for value-based care.

A variety of barriers

It is not all positive news, however. In 2017, only 8% of family physicians agreed with the statement that “quality expectations are easy to meet in value-based payment models,” compared to 13% in 2015. Plus, 62% cited "lack of evidence that using performance measures results in better patient care" as a barrier to adoption.

Even the finding that little more than half of physicians said their practice participates in value-based care models shows there is still work to be done. 

"If you didn’t already know, physicians are a skeptical bunch," Mullins said, later adding, “we are slow adopters for lots of things.” 

And while the share of family physicians who have contracts with 10 or more payers remained about the same, Mullins said it’s still noteworthy that it’s as high as 37%. That illustrates how “frustrating and exhausting” it can be for physicians to deal with the myriad quality measures and systems associated with each payer, she added.

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One potential barrier not covered in the survey is the uncertainty over what will happen with the Center for Medicare and Medicaid Innovation, Micklos said, noting that Medicare has long been the driver of what happens with the rest of the industry. The Trump administration has asked industry stakeholders for input on an effort to take the innovation center in a "new direction.”

The panelists were less concerned, though, with the administration’s move to end mandatory bundled payment models. Regardless of what specific policy levers are pulled, the move to value is smart for the private sector, as fee-for-services has a “tremendous amount of demonstrable inefficiencies,” said Roy Beveridge, M.D., Humana’s chief medical officer and senior vice president.

Micklos agreed, adding that bringing people “screaming” into certain payment models isn’t the most sustainable concept anyway.

The IT factor

A little more than half of the physicians surveyed said their practices were updating or adding IT infrastructure to prepare to participate in value-based care models. The same share—54%—said as much in 2015.

As important as that is, though, physicians still must have better, easier-to-understand and more timely data to truly move forward on connecting payment to health outcomes, Mullins pointed out.

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In that effort, insurers can be a crucial partner, Beveridge said. They have a tremendous amount of analytics and other supports to offer physicians, he said, and thus have the responsibility to share that with physicians so that they can act upon it.

One of the biggest issues that both payers and providers continue to face, however, is the lack of interoperability between electronic health records systems.

From Humana’s point of view, “some of the barriers for interoperability really should not exist,” Beveridge said. But Mullins added that “I don’t know if there is a light at tend end of the tunnel or not,” on fixing the issue.