How to partner with physicians on the journey to value

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To successfully transition to value-based care, health systems must engage their physicians in the process.

Figuring out the best way to engage physicians, however, is often one of the toughest challenges for organizations as they move from traditional fee for-service (FFS) models to models based on the efficient delivery of high-quality care.

Physicians drive the bulk of utilization decisions that influence health outcomes, which is one reason their buy-in is critical for transforming care delivery. Success in this new model requires physicians to adapt to a new way of practicing medicine, as well as to adjust to a new compensation model that rewards clinicians for providing high-quality care and containing costs, rather than on the volume of care provided.

The transition may be particularly tough for primary care physicians (PCPs) who are now called to serve as care quarterbacks. In this new world, PCPs will be tasked not only with serving the patients in front of them, but also starting to manage entire patient panels outside of the four walls of their clinics. Unfortunately, physicians are not always prepared to take on these additional tasks and must first overcome a number of systemic hurdles.

Understanding current hurdles
Health systems attempting to engage physicians in the transition to value should be cognizant of factors that add to the challenge. For example, until recently most physicians have not been educated on the principles of newer care models based on the delivery of cost-effective outcomes, nor on population health management. Only now are medical schools beginning to incorporate these subjects into their curricula—but the impact remains to be seen. They also must address the ongoing challenge of how to influence physician behavior during the gradual shift away from FFS. Because physicians are still mostly paid on a fee-for-service basis, rather than for coordinating care and quality improvement, they have remained focused on providing more services that drive higher reimbursements.

Physicians must also adapt to new care coordination requirements. Traditionally no one provider has been responsible for tracking a patient’s care across all provider types and care settings. What makes it even more challenging is that technologies were not built to support this effort—they were built to sustain the FFS model. Physicians haven’t had to worry about financial penalties for duplicating care, nor for missing opportunities to improve patients’ health. Furthermore, physicians have lacked technologies to help advance care coordination efforts because legacy IT systems were designed primarily to support FFS billing functions and lack interoperability. Value-based care models, however, require PCPs and their care teams to manage care more effectively.

In addition, the pressure of these many hurdles is magnified for PCPs because of the historical undervaluation of their services in comparison to their specialist counterparts – despite the complexity and variety of conditions seen in primary care. Meanwhile, physicians are overburdened with regulatory and administrative requirements that squeeze them financially and reduce the amount of time spent on patient care. Attempts by payers and purchasers to enforce value-based behaviors using diverse metrics and proprietary programs add to the overload – particularly if physician compensation is not properly aligned. With all these pressures, it’s little wonder that physicians are experiencing widespread career dissatisfaction and burnout.

Taking a programmatic approach to drive change
Given all these challenges, how can a health system successfully engage physicians in value-based initiatives? Ideally organizations should adopt a holistic, prescriptive methodology that is supported by people, processes and technology and strives to achieve the Triple Aim plus One – that is, improved clinical outcomes, lower costs and higher patient satisfaction, plus better physician engagement.

To successfully engage physicians and drive change, consider this programmatic approach:
1) Analyze opportunities and measure the organization’s baseline capabilities to identify targets for initial improvement efforts.
2) Establish physician-led governance, a strong clinical leadership team, and a network of high-performing physicians who share a common vision for better care at a lower cost. It’s key to creating a culture of accountability and implement mechanisms for financial outcome accountability.
3) Align incentives by revamping physician contracts at the group and individual physician levels to emphasize value over volume, to encourage physicians to meet quality and cost goals, and to support higher risk models over time.
4) Enhance care improvement by structuring the care model to deliver accountable primary care. Assess current care management programs and add new offerings as needed.
5) Enable behavior change among physicians and care team members through effective training, education and workflows. In addition, implement technology and tools that provide actionable clinical and financial information at the patient and population level.
6) Build on successes by leveraging data, programs and knowledge resources to find and act upon new opportunities for financial and clinical improvement. Monitor internal and external factors so the organization can adapt to changes in the patient population, the market and government regulations.
For systems to succeed in value-based contracts, physicians must be engaged partners in the process. Health systems and payers must view physicians as strategic assets that deserve the necessary training, operational support and technology investments to succeed in a value-based world.

A comprehensive physician engagement strategy is critical. Organizations must consider information technology needs, create the right governance structure and provide clinicians with educational and mentoring options. The strategy must also align physician payment and provider workflows with the organization’s financial and clinical goals that drive cost-effective, high-quality outcomes.

The transition to value-based care can be challenging – and more so if physicians are not engaged in the process. However, organizations can position themselves for value-based success by embracing a comprehensive and prescriptive strategy that addresses the needs of physicians and positions them for success.

Joe Gifford, MD, Senior Vice President of Provider Markets, Lumeris

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