This recent study conducted by AAFP and funded by Humana captures a key concern family physicians have with value-based payment models. 62% of physicians say there is a “lack of evidence that using performance measures result in better patient care” and 58% say “VBP will increase work for physicians without a benefit to the patient”. In a FierceHealthcare article titled “Humana study: Physicians warm to value-based pay models, but skepticism runs deep,” Dr. Amy Mullins, medical director of quality improvement for AAFP, states that “If you didn’t already know, physicians are a skeptical bunch… we are slow adopters for lots of things.” I would argue it has as much to do with experience as skepticism.
Take these recent findings released in the past few weeks for example. Pay for performance (P4P) programs may have inadvertently exacerbated healthcare disparities and shifted money away from physicians who treated sicker, poorer patients to pay for bonuses according to this Healthcare Finance News article. Hospital readmission reduction programs (HRRP) may be linked to higher mortality rates for heart failure patients as reported in this Modern Healthcare article. Over time, more studies will come out like this. This is not to say that P4P or HRRPs are necessarily bad – there are peer-reviewed academic articles arguing for the benefits of these programs as well. What is clear though is that we are entering a steep learning curve as we deploy first generation value based care programs into the market. It is similar to how we learn in medicine – it will take a body of evidence over a period of time to form a solid understanding of value based care. And it will take evolving value based care programs as we learn over time.
So experience tells us we do not yet know what works and what needs to be tweaked. Yet we are asking physicians to take on the burden of implementing first generation solutions, at great cost to their practices.
What are your thoughts, comments, insights?
