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Topics

CMS Office of the Actuary publishes annual price tag; physicians got $978 billion of it.

U.S. health care spending hits $4.9 trillion in 2023

How to stop accepting Medicare in your practice.

Opting out of Medicare

Health care organizations respond to ‘mixed bag’ bill.

Telehealth, PBM reforms part of House year-end spending plan

ACP also calls for action on prior authorizations.

Clock is ticking for 2024 action on Medicare physician reimbursement, PBM reforms

Respondents citing financial hardship as a reason for non-adherence to asthma medications had nearly double the odds of an asthma attack and more than 60% heightened risk of requiring ED care.

Cost prevents 1 in 6 U.S. adults with asthma from following prescription, study finds 

Value-based payment: An introduction to a study

Value-based payment: Sources and a summary

Value-based payment: Will it cover the cost of doing business?

Value-based payment: Or is it fee-for-service? Or both?

Value-based payment: Not all insurers are on board

Value-based payment: Health systems don’t support doctors

Value-based payment models: Workforce shortages are a problem

Value-based payment models: Problematic performance measures 

Value-based payment models: Too much documentation

Value-based payment models: Potential solutions, part 1

Value-based payment models: Potential solutions, part 2

Value-based payment models that focus on patient health sound like a great idea.

So why don’t more physicians use those programs instead of fee-for-service 

 that remain a substantial part of the health care economy?

 were not participating in value-based payment models. Researchers from Mathematica wanted to find out why, so they went to the source: a dozen primary care physicians, primary care management experts and focus groups with 17 frontline physicians and other clinicians. None of them had any prior participation in value-based payment models.

Their responses were compiled for the study, 

“Why Primary Care Practitioners Aren’t Joining Value-Based Payment Models: Reasons and Potential Solutions,”

In this video series, co-author Ann S. O’Malley, MD, MPH, discusses the findings. Lessons from 14 years of value-based payment models could shape how physicians adopt them in the future – and ultimately improve patient health.

Co-authors are Rumin Sarwar, MSPH, Cindy Alvarez, MPH, and Eugene C. Rich, MD, of Mathematica.

Videos

Value-based payment models, designed to enhance patient health, are not widely adopted by primary care physicians, who predominantly use fee-for-service models. A study by Mathematica, involving primary care physicians and management experts, explored the reasons behind this reluctance. The study, published by The Commonwealth Fund, highlights insights from 14 years of value-based payment models and suggests potential solutions for increased adoption. The findings, discussed by co-author Ann S. O’Malley, MD, MPH, aim to guide future implementation and improve patient outcomes.

Researchers asked doctors why they continue with fee-for-service payment. There are many reasons, as a study co-author explains.

Why physicians don’t participate in value-based payment models

 would help attract greater participation in value-based 

. Current doctors also need more training and support in integrating value-based care principles into their practices. Ann S. O’Malley, MD, MPH, a researcher for Mathematica, discusses potential workforce solutions suggested in the study, 

“Why Primary Care Practitioners Aren’t Joining Value-Based Payment Models: Reasons and Potential Solutions.”

Increasing the number of primary care physicians could enhance engagement in value-based payment models. Existing practitioners require additional training and support to effectively incorporate value-based care principles into their practices. Ann S. O’Malley, MD, MPH, from Mathematica, explores workforce solutions in the study "Why Primary Care Practitioners Aren’t Joining Value-Based Payment Models: Reasons and Potential Solutions." The study emphasizes the need for strategic workforce development to overcome barriers and foster greater participation in these models, ultimately improving healthcare delivery and outcomes.

A physician researcher discusses why primary care physicians do not participate in value-based payment models.

Prospective payments, fewer metrics and less distortion in reimbursement for primary care all would 

. Ann S. O’Malley, MD, MPH, a researcher for Mathematica, discusses potential solutions suggested in the study, 

Primary care doctors spend so much time logging patient data that they don’t have time to care for patients, and 

. Ann S. O’Malley, MD, MPH, a researcher for Mathematica, discusses findings about physician and patient documentation in the study, 

Primary care physicians face significant challenges in adopting value-based payment models due to the extensive time required for patient data documentation, which detracts from direct patient care. This administrative burden is a key barrier to participation in these models. The study by Ann S. O’Malley highlights the need for solutions to streamline documentation processes, allowing physicians to focus more on patient interactions. Addressing these issues could enhance the adoption of value-based models, ultimately improving healthcare delivery and outcomes.

Value-based payment models: Problematic performance measures

he best way to measure patient outcomes? “Measuring that is very tricky to do, and we don't do it that well,” said Ann S. O’Malley, MD, MPH, a researcher for Mathematica. Here she continues explaining some of the 

Value-based care aims to improve patient outcomes while controlling costs, but measuring these outcomes remains challenging. Ann S. O’Malley, MD, MPH, highlights the difficulties in accurately assessing performance in value-based models. The study "Why Primary Care Practitioners Aren’t Joining Value-Based Payment Models: Reasons and Potential Solutions" explores these challenges, emphasizing the complexity of outcome measurement and the reluctance of primary care practitioners to adopt these models. Potential solutions are discussed to address these barriers and enhance the effectiveness of value-based care.

 does not have enough doctors, clinical staff and support for primary care. Ann S. O’Malley, MD, MPH, a researcher for Mathematica, discusses some of the workforce implications of the study, 

The U.S. healthcare system's shortage of doctors, clinical staff, and primary care support hinders participation in value-based payment models. Ann S. O’Malley, MD, MPH, highlights workforce challenges and potential solutions in her study. The study identifies barriers such as inadequate staffing and support, which deter primary care practitioners from engaging in these models. Addressing these issues is crucial for enhancing participation and improving healthcare delivery. Solutions may include increasing workforce capacity and providing better support systems to facilitate the transition to value-based care.

Health systems that participate in value-based 

 providing the frontline care. That can become a financial challenge for doctors. Ann S. O’Malley, MD, MPH, a researcher for Mathematica, continues explaining some of the financial findings of the study, 

Value-based payment models in health systems often fail to allocate sufficient resources to frontline physicians, posing financial challenges for these practitioners. This misalignment can deter primary care practitioners from participating in such models. Ann S. O’Malley, MD, MPH, highlights these financial issues in her study, "Why Primary Care Practitioners Aren’t Joining Value-Based Payment Models: Reasons and Potential Solutions." The study explores the reasons behind the reluctance of primary care practitioners to engage with value-based models and suggests potential solutions to address these financial and resource allocation challenges.

Do physicians work with a fee-for-service payment model? Value-based payment? Or both? Fee-for-service payment is distorted for 

 do not eliminate that. Ann S. O’Malley, MD, MPH, a researcher for Mathematica, continues explaining some of the financial findings of the study, 

Physicians often operate under both fee-for-service and value-based payment models. Fee-for-service models are particularly problematic for primary care reimbursement, as they can distort incentives and fail to adequately compensate primary care services. Value-based payment models, while designed to address these issues, do not fully resolve the challenges faced by primary care practitioners. The study "Why Primary Care Practitioners Aren’t Joining Value-Based Payment Models: Reasons and Potential Solutions" explores these financial dynamics and suggests potential solutions to encourage primary care practitioners to adopt value-based models.

 cover the costs of operating an independent medical practice? 

 because they are unsure that model will do so. Ann S. O’Malley, MD, MPH, a researcher for Mathematica, explains some of the financial findings of the study, 

Value-based payment models aim to improve healthcare quality and reduce costs, but their financial viability for independent medical practices remains uncertain. Physicians express caution due to concerns about covering operational costs under these models. Ann S. O’Malley, MD, MPH, highlights financial findings from a study exploring why primary care practitioners hesitate to adopt value-based payment models. The study identifies barriers such as financial risk, administrative burden, and inadequate incentives. Potential solutions include better support, risk adjustment, and aligning incentives to encourage participation in value-based care.

 is to improve patient outcomes while changing 

. Ann S. O’Malley, MD, MPH, of Mathematica, is co-author of the 2024 study, 

 Here she introduces the study and what she and fellow researchers wanted to learn.

Value-based payment models aim to enhance patient outcomes by altering primary care compensation structures. Ann S. O’Malley, MD, MPH, from Mathematica, co-authored a 2024 study exploring why primary care practitioners are hesitant to adopt these models. The study seeks to identify the barriers preventing practitioners from joining value-based payment systems and proposes potential solutions to encourage participation. Understanding these challenges is crucial for the successful implementation of value-based care, which ultimately strives to improve healthcare quality and efficiency.

A physician researcher discusses why primary care physicians do not participate in value-based payment models. 

Medicare & Medicaid

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