May 23, 2019
Can Physicians Be Sold on Value-Based Care?
Part of the skepticism reflects a concern that the concept of “value” in healthcare may be nebulous, and that value-based reimbursement can’t account for the considerable nuance involved in doctor-patient relationships.

More and more caregivers say at least a portion of their compensation is tied to value-based care metrics (47%, according to a 2018 survey of nearly 9,000 physicians  — up from 42% in 2016), but they still need some convincing that the transition is a positive one.

In fact, when asked to what extent they agreed or disagreed with the statement, Value-based compensation is likely to improve quality of care and reduce costs, only about 20% were fully onboard. Another 25% were taking a wait-and-see approach, and the rest expressed skepticism in varying degrees.

Furthermore, even if providers expect cost savings to result, that by itself isn’t necessarily enough to get them onboard, research from Bain & Company suggests. A 2017 survey found that more than 70% of physicians prefer fee-for-service even if it turns out to be more expensive. “Physicians are unwilling to change,” says Bain, “until it is clear that these models deliver the same or better clinical outcomes.”

Still, if you dig a little deeper, you’ll find that much of the skepticism is rooted in areas that are ripe for  transformation. As caregivers become more accustomed to the changing landscape and the tools available to them, their attitudes may shift, as well.

 

How to define value

Part of the skepticism reflects a concern that the concept of “value” in healthcare may be nebulous, and that value-based reimbursement can’t account for the considerable nuance involved in doctor-patient relationships.

For example, are high patient-satisfaction scores more likely to result from the physician acceding to the patient’s wishes or acting in the patient’s best interest? Does an emphasis on value encourage practitioners to concentrate on healthier patients and discourage them from seeing sicker patients? What about patients who steadfastly refuse to follow advice. Should physicians be penalized for the stubbornness of patients?

Additionally, physicians say they often lack the data they need to provide better value. A survey by Deloitte found that 72% consider cost data valuable, especially at the point of care, but that only 28% are given adequate cost information related to resource use, other physicians and facilities to which they refer, and patient out-of-pocket costs.

 

EHRs and burnout

And then there’s the less-nuanced component of physician resistance. Quite frankly, EHRs have a lot of doctors pulling their hair out.

“Quit making us document a ton of stuff that isn’t applicable to our particular practice and that stops us from being able to work with our patients to achieve better outcomes,” complains one anguished survey respondent, adding that having to document data and look at lab results late into the night “leads to physician burnout and lack of empathy for our patients.”

It’s an all-too-common complaint. The survey that uncovered strong disagreement with the expectation that value-based compensation will improve care and reduce costs also found that 78% of respondents “sometimes, often or always experience feelings of burnout.” Patient relationships, say most, are their greatest source of professional satisfaction; EHRs are their greatest source of professional dissatisfaction. Fifty-six percent say they’ve reduced efficiency and 66% say they’ve reduced patient interaction.

 

Changing hearts and minds

The complaints and concerns are valid. Healthcare organizations need to do a better job of engaging clinicians, says Bain. They need to provide a clinical rationale for changing the way care is delivered.

There are also plenty of practical and actionable steps providers and organizations can take to ease their administrative burdens and shift the emphasis back toward patient interaction and patient engagement.

For example, many studies have shown that medical scribes are a cost-effective solution for physicians who feel burned out, and who wish they had more face-to-face time with patients. ScribeAmerica scribes ease workloads, improve communication and relieve overwhelmed physicians from the tedium of bureaucratic tasks. By reducing the pressures caused by the insatiable need for data, they can help smooth the sometimes rocky transition from volume-based care to value-based care.

CareThrough navigators are another cost-effective solution. Well-trained in the critical strategies needed for transitioning to value-based care, they can free up clinical staff to focus more intently on efficiency, quality of care and patient satisfaction. They develop personal relationships with patients and know how to motivate them to become more active stewards of their own well-being. That, among many benefits, reduces the likelihood that providers will be penalized as a result of patient non-adherence.

Artificial intelligence is another area in which major advances are rapidly improving efficiency and outcomes. Patients love LifeLink’s highly sophisticated chatbots, which conversationally interact with them exactly the way they “chat” with family and friends, via text messages. By applying machine learning and using intelligent messaging, chatbots can identify a range of questions and prompts, use patient-specific data to facilitate every conversation, and respond appropriately. They also deliver the data gleaned from those conversations back to the EHR, creating an ever-expanding loop of information that improves diagnoses, outcomes and satisfaction.

In this rapidly changing world, more than 60% of physicians say they’re pessimistic about the future of medicine. But when the right tools are available, the outlook begins to look much brighter.

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