Value-based care has worked better on paper than in practice, and a new research letter in JAMA Health Forum offers a possible explanation for the disparity: administrative overkill.
The first-of-its-kind analysis tracked 890 primary care physicians in value-based care contracts from 2020 to 2022, finding that:
- PCPs tracked an average of 57 quality measures.
- The average VBC contract contained an average of 10.2 quality measures.
- The average number of VBC contracts held went from 9.4 in 2020 to 12.3 in 2022.
- This chart has the full breakdown.
The first bullet alone shocked the authors of the study, as well as most industry onlookers who
expected payors to have some form of quality measure coordination.
- The fact that the PCPs held an average of 11 VBC contracts with 10 quality measures each, and still managed to have 57 different quality measures shows how little coordination (if any) actually takes place.
- Extrapolate that administrative burden to an average panel size of 1,309 patients, and it’s no surprise that more providers aren’t lining up to jump on the VBC bandwagon.
What would help the situation? Although out of scope for this study, a well-timed Commonwealth Fund focus group with 29 PCPs explored answers to that exact question.
- The PCPs were concerned that many utilization and cost measures unfairly penalized them for outcomes beyond their control (ex. acute hospitalizations and total Medicare expenditures are also affected by other providers and specialists), and felt these measures should only apply to health systems or ACOs rather than small practices.
- The PCPs thought measures of access (ex. appointment availability, wait times) and continuous care (ex. repeat visits with the same doctor, communication) would better reflect true high-quality care.
- The lack of alignment across models and payors caused PCPs to use more time “meeting the requirements of payors than meeting needs of patients,” and they urged the government/employers to encourage consistent measures and reporting requirements.
The Takeaway
If value-based contracting is intended to promote high-quality care, does having doctors try to optimize for 50 different quality measures really accomplish that? An uncoordinated approach is not only unsustainable, but also counterproductive. Quality measures that amount to visit distractions and provider burnout aren’t a recipe for long-term success, and this study makes it clear that better coordination is a missing ingredient.
