Survey: Physicians skeptical about value-driven payment models

Most physicians don’t believe accountable care organizations (ACOs) or bundled payment programs will effectively drive down America’s burdensome healthcare costs, according to a survey released by Leavitt Partners.

Just 21 percent of 621 physicians said bundled payments can lower costs, compared to 46 percent of the 538 surveyed employers. Similarly, 22 percent of physicians and 48 percent of employers said ACOs could lower costs.

“Physicians are more optimistic about reforms that involve patient engagement and less optimistic about reforms that impact their payment,” wrote survey authors Lia Winfield, PhD; Brooke Zollinger, MSc; and David Muhlestein, PhD, JD. “Thus, there is a need to create incentives for physicians to transition away from a fee-for-service environment and toward value-based payment models. A business case for value must be made and continual engagement with providers on reform efforts and care delivery transformation is important.”

At least half of both physicians and employers agreed cost transparency, increased emphasis on wellness and prevention, better management of heavy utilizers of care and improved management of behavioral and mental health could result in cost savings. Improving wellness and prevention efforts drew the highest consensus (60 percent) among both groups.

The authors suggested reforms in these areas could be easier to implement given the shared commitment of key stakeholders.

Here are other notable findings from the survey, which also included responses from 5,031 consumers:

• 90 percent of physicians, 83 percent of consumers and 74 percent of employers believe the U.S. healthcare system requires fundamental changes or a complete overhaul. Consumers (24 percent) were most likely to think it needs a full rebuild.
• All respondents thought the government and insurance companies were the most to blame for the country’s healthcare problems. Physicians (52 percent) were most likely to put the responsibility on insurance companies, while consumers (47 percent) blamed the government more than employers (32 percent) and physicians (31 percent). Pharmaceutical companies were the next in line, receiving 15 percent of the vote from both employers and physicians and 6 percent of the doctors’ vote.
• 13 percent of physicians had never heard of the 2015 Medicare Access and CHIP Reauthorization Act (MACRA) and another 47 percent said they recognized the name but weren’t familiar with its requirements. Only 4 percent believed they had in-depth knowledge of the law.
• Even though most consumers felt the U.S. healthcare system required change, 72 percent of respondents said their insurance plans met their family’s needs “extremely well” or “very well.”

“Physicians, employers, and consumers all agree that fundamental changes are needed to make the U.S. health system work better; however, physicians and employers disagree on which payment reform efforts will work, who is responsible for driving reform, and which are the most important barriers to overcome,” wrote Winfield, Zollinger and Muhlestein. “Understanding where these groups agree and disagree enhances our knowledge of the state of healthcare today and the best next steps for tomorrow.”