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

Key Takeaways

  • Value-based payment models aim to improve patient health but are not widely adopted by primary care physicians.
  • Mathematica's study involved primary care physicians and management experts to understand the reluctance towards value-based models.
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Researchers asked doctors why they continue with fee-for-service payment. There are many reasons, as a study co-author explains.


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 payment models that remain a substantial part of the health care economy?

As of 2024, most primary care physicians 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,” published by The Commonwealth Fund.

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.

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