How is the United States faring in terms of phasing out fee-for-service health care and replacing it with a value-based system? New research shows some momentum, but much work remains.
For the second year in a row,(ddx.questdiagnostics.com) Quest Diagnostics and Inovalon, a leading technology company, commissioned a study to find evidence that the needle is moving in this direction. The 2017 study, titled "Progress on the Path to Value-Based Care,"(ddx.questdiagnostics.com) was released last month.
Results of the latest study were based on the responses of 452 individuals who participated in an online survey undertaken April 7-17. Of those respondents, 302 were primary care physicians -- all employed in private practices but also affiliated with hospitals -- and 150 were health plan executives.
"Overall, the study shows progress toward valued-based care, but that progress has been slow because physicians lack the appropriate tools to close gaps in health care," said Patrick James, M.D., chief clinical officer of health plans, policy and medical affairs at Quest Diagnostics, in an interview with AAFP News.
- New research shows that the U.S. health care system is making progress in transitioning from fee-for-service to a value-based system.
- The percentage of health plan executives and physicians who think the United States has achieved value-based health care increased from 25 percent in 2016 to 29 percent in 2017.
- Responses from health plan executives and physicians did not align on certain key points; for instance, 75 percent of executives and just 54 percent of physicians said electronic health records had everything physicians need.
Authors found that the percentage of surveyed physicians and health plan executives who think the U.S. health care system already has achieved value-based status increased to 29 percent in 2017 from 25 percent in 2016.
- Other comparisons between the 2017 and 2016 surveys show positive movement related to
- physicians and payers who said physicians have the tools to succeed in a value-based health care system (46 percent versus 34 percent),
- physicians who were satisfied with the availability within their workflow of patients' health information (48 percent versus 36 percent), and
- physicians who were likely to use a tool in the clinic that provides real-time medical history insight, as well as on-demand, patient-specific data to identify gaps in quality, risk and utilization (87 percent versus 85 percent).
Additionally, the percentage of physicians who said they lack needed information about patients dropped from 65 percent in 2016 to 62 percent in 2017.
Areas of Focus
The survey revealed some areas of disconnect between health plan executives and physicians. For instance, 70 percent of health plan executives said progress has been made in aligning health plans and physicians in the quest for value-based care; just 47 percent of physicians agreed.
This indicates "an opportunity for greater alignment" in this area, said James.
On the other hand, a whopping 83 percent of physicians and health plan executives agreed that alignment between the two groups was crucial to providing value-based care.
When asked about the availability of tools needed to achieve valued-based care, 53 percent of health executives said physicians already had those tools, but just 43 percent of physicians agreed.
Study authors speculated that a possible reason for the "striking gap in perception" on this topic centered on "differing views about the value of EHRs" (electronic health records).
They noted that 75 percent of executives -- and just 54 percent of physicians -- said EHRs had everything physicians need.
- 70 percent of physicians did not clearly link EHRs with improved patient outcomes and
- 65 percent of physicians said they'd like to be able to pull patient-specific information related to performance or quality measures from their EHR.
Assessing the Results
What's the significance of this information moving forward?
"In our study, 71 percent of physicians said they'd be willing to spend more time using technology if EHRs could yield insights unique to patients," said James. "And 87 percent of physicians and health plan executives agreed that access to quality and performance measures specific to patients would be key to achieving value-based care.
"This reveals that both physicians and payers want more from EHRs, so there is a path forward, particularly if extending the value of EHRs can lead to improved patient care and lower costs," he added.
Authors suggested that co-investment in health IT (HIT) could be the key to progress.
"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," they wrote.
James agreed and added that 85 percent of health plan executives polled in the study said that co-investment in HIT by health plans and physicians would accelerate value-based care. As an example, he said health plans are sometimes willing to shoulder the costs of technology that gives physicians actionable, patient-specific data that includes quality metrics.
"They believe that over time, it will pay off in the form of better financial performance," James said.
James described the level of progress toward value-based care this way: "The study shows that progress has been made over the past year, but obstacles still persist. Chief among them are differing perceptions of health plan executives and physicians about the tools and data needed to deliver on value-based care."
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