Physicians, Health Plans See Common Goal in Value-Based Care

Ken Terry

July 27, 2017

Despite differing perceptions by doctors and insurance companies about the pace of change in healthcare, both parties believe that better alignment between healthcare providers and health plans could accelerate the shift to value-based care, according to a recent survey sponsored by Quest Diagnostics and Inovalon, a health technology company.

Most physicians and health plan executives also believe that the industry's transition to value-based care will continue, regardless of what happens in Washington with the various Republican healthcare proposals, the survey shows.

The Quest survey, which was conducted for the second year in a row, included 452 respondents. Of those, 302 were primary care physicians in private practices, and 150 were health plan executives.

The survey respondents acknowledged that fee for service still dominates healthcare. The percentage of respondents who said the system was already based on value-based care rose from 25% in 2016 to only 29% in 2017. However, nearly twice as many doctors (31%) who had been in practice for 20 years or less thought so, compared to those in practice 21 years or more (16%).

Seventy percent of health plan executives but only 47% of doctors believed that progress is being made toward the alignment of payers and providers to accelerate the adoption of value-based care. But 83% of respondents said there was a need for cooperation between the two parties to achieve this goal.

Forty-three percent of doctors and 53% of health plan executives said that physicians had the tools they needed to succeed in value-based care. By contrast, in 2016, only 29% of doctors and 44% of insurance executives answered that question in the affirmative.

The EHR Gap

Providers and health plan executives also had different views regarding electronic health records (EHRs). Seventy-five percent of executives but only 54% of doctors said EHRs could provide all Internet technology (IT) support necessary for value-based care. In addition, 70% of physicians said they saw no clear link between EHRs and better patient outcomes.

Nevertheless, 71% of doctors said they'd spend more time using technology if their EHRs could yield insights unique to their patients. This reflects another survey finding: fewer than half (48%) of physicians are satisfied with access to patient information within their workflow. Although this was an improvement over the 36% of doctors who were satisfied with data access in 2016, it shows that physicians still are unhappy about the functionality of their EHRs.

The kinds of information that physicians wanted at the point of care were performance measures that apply to the individual patient (36%), a list of gaps in care that affect quality measures (29%), more information about each patient's history (21%), and data that help doctors input diagnostic codes accurately (12%).

Eighty-five percent of doctors said access to quality and performance measures specific to patients is essential to achieving value-based care. On this point, most health plan executives agreed.

Eighty-seven percent of physicians said they'd likely use a tool that provides on-demand, patient-specific data to identify gaps in quality, risk, and utilization, as well as medical history insights delivered within the clinical workflow in real time.

Eighty-five percent of health plan executives said coinvestment in health IT by payers and providers would accelerate adoption of value-based care. Seventy-seven percent of the executives also said the investments made in technology for quality initiatives have improved the value of their members' healthcare.

Insurers financially benefit more than providers do from value-based care, yet physicians and hospitals have to bear the bulk of the IT costs. Therefore, it would make sense for plans to coinvest in provider IT, the survey authors said.

Aetna and some other national plans provide claims data to at-risk healthcare organizations and help them crunch that data. Aetna has also provided data-driven insights to some of its provider partners in accountable care organizations. But beyond that, physicians and other providers are still waiting for health plans to help them buy software – of interest to physicians who have had to shoulder the cost of EHRs alone since their meaningful use incentives expired.

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