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Lack of preparedness, mixed messages, delay shift to value-based care
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The U.S. health care system continues to struggle in its transition from fee-for-service to value-based care.
This challenge was illustrated in a recent survey by Quest Diagnostics of 300 primary care physicians that showed only 27% believed the health care system is value-based, while another 67% suggested the U.S. has a fee-for-service system.
“These results demonstrate one of the big things we’ve learned from the movement toward value-based care — that we’re not ready,” Alan Dow, MD, MSHA, Healio Family Medicine editorial board member and general internist at Virginia Commonwealth University, said in an interview.
“Our tools aren’t good enough and frankly most of us weren’t trained to think about population health. We’ve got so much fragmentation and, as we’ve been trying to overcome those gaps and provide value, we’ve realized things are worse than we thought,” he added.
L. Patrick James, MD, chief clinical officer at Quest Diagnostics agreed as he discussed the results of his company’s survey with Healio Family Medicine.
“The same issues that physicians and health plan executives cited as barriers to value-based adoption 3 years ago continue to stymie its adoption today,” James said. “These include lack of access to the right data and tools as well as complex quality measures and lack of interoperability.”
Dow said the change in the presidential administration nearly 2 years ago added confusion.
“The Obama administration believed in value-based care and took some substantive steps through the [Affordable Care Act] to encourage value-based models,” Dow said. “Not all of those ideas were rolled out or worked as planned, but it was a clear direction. For the moment, we are in a holding pattern though the recent changes to the fee schedule might encourage more value-based models.”
In an attempt to move the concept forward, HHS Secretary Alex Azar made several speeches this spring that outlined how the Trump administration viewed value-based care.
“The four areas of emphasis are the following: giving consumers greater control over health information through interoperable and accessible health information technology; encouraging transparency from providers and payers; using experimental models in Medicare and Medicaid to drive value and quality throughout the entire system; and removing government burdens that impede this value-based transformation,” Azar said to both America’s Health Insurance Plans and the Federation of American Hospitals.
However, Tom Price, MD, the first HHS Secretary under Trump had a different message, according to The New York Times.
Last November, the newspaper reported that Price defended the fee-for-service model in front of what was then called CAPG, the Voice of Accountable Physician Groups, and pushed for new payment models.
“We ought to recognize that fee-for-service may not be the end of the world,” Price told the group.
Even with Price’s departure in September 2017, the Times article suggested that there are still many within HHS that share his views. The same article also quoted CMS Administrator Seema Verna as saying that how the agency defined value and quality “is a problem.”
Mixed messages aside, Dow said value-based care is a “good idea” for both doctors and patients, but also said there are limited options.
“It may be the only way forward. We spend 18% of our gross domestic product on health care and have a deficit of a trillion dollars per year, much of which is related to health care spending,” Dow said. “Controlling health care costs is a big part of solving our budget deficits so value-based care is an imperative for our broader society.
“In addition, value-based care, done well, is the right thing for patients. It means providing the evidence-based, cost-effective care people deserve and no more. A lot of our care is wasteful and that exposes patients to unnecessary side effects or risk,” he continued, adding that PCPs and internists need to start thinking differently about how high-cost patients are treated.
James suggested some ways to change mindsets.
“Physicians can help themselves by sharing their challenges with their payer colleagues and the types of tools and data they and their care teams need. Don’t assume the health plan executives understand these challenges, because, as our survey shows, they may not,” he said in an interview. “Greater collaboration is essential.”
James also suggested PCPs and internists seek out technologies that meet value-based care requirements.
“Questions to ask EHR providers should focus on how the platform can help meet quality metrics and other measurements on which payment is increasingly made,” he said, noting that even with such forward-thinking systems in place, value-based care will not happen overnight.
“There clearly isn’t a quick fix, and it will take time to [make this] transition,” he said in an interview. – by Janel Miller
References:
America’s Physicians Groups. About. http://www.apg.org/index.aspx?page=2. Accessed Aug. 16, 2018.
HHS.gov. https://www.hhs.gov/about/leadership/secretary/speeches/2018-speeches/remarks-on-value-based-transformation-for-post-acute-care.html. Accessed Aug. 16, 2018.
HHS.gov. https://www.hhs.gov/about/leadership/secretary/speeches/2018-speeches/remarks-on-value-based-transformation-to-the-federation-of-american-hospitals.html. Accessed Aug. 16, 2018.
HHS.gov. https://www.hhs.gov/about/leadership/secretary/speeches/2018-speeches/remarks-on-value-based-transformation-and-innovation.html. Accessed Aug. 22, 2018.
HHS.gov. https://www.hhs.gov/about/leadership/secretary/speeches/2018-speeches/value-based-transformation-of-americas-healthcare-system.html. Accessed Aug. 22, 2018.
NYTimes.com. “Trump administration challenges consensus on reducing costs.” https://www.nytimes.com/2017/11/12/health/doctor-pay-trump.html. Accessed Aug. 17, 2018.
Disclosure s : Dow is author of the book “Handbook of Interprofessional Practice: A Guide for Interprofessional Education and Collaborative Care.” James is chief clinical officer at Quest Diagnostics.