The Commonwealth Fund has published the results of a study seeking to understand why more primary care providers (PCPs) are not participating in value-based payment (VBP) models.
After conducting focus groups with PCPs who have not participated in VBP models and interviews with primary care executives and association leaders, the report offers some recommendations on how to improve PCP engagement.
The report notes that over the past 14 years, CMS and states have tested various VBP models for primary care, but most primary care physicians still do not participate in VBP models, and the reasons are largely unknown. (A 2022 survey found that only 46 percent of primary care physicians reported receiving any value-based payment. Smaller, independent, and less-resourced practices that serve 39 percent of traditional Medicare beneficiaries are the least likely to apply to VBP models.)
Summarizing what they heard from focus group and interview participants, the report’s authors noted that PCPs’ enthusiasm for VBP models is tempered by financial barriers, PCP workforce shortages, and what they perceive as imperfect performance measures.
In terms of resources and finances, here’s an example from the study: Some health systems participating in VBP models are not providing frontline primary care physicians or practice sites with the resources needed to meet the model’s requirements. One expert said health systems are “using their contracting authority to [join a model] on behalf of those physicians, but not reliably transmitting those resources to the primary care practice.” For example, two PCPs said that when they requested more nurses at practice sites, the health system hired a nurse but placed her in the corporate office. An expert who works with primary care practices across health systems said that system-owned practices that function well in VBP models shift resources to support changes in care delivery at practice sites.
In the realm of quality measurement, primary care physicians expressed concerns about documentation burdens as well as fears that current quality measures used in value-based payment models impede their ability to deliver high-quality care. “Value-based payment models link the amount health care professionals earn for their services to the outcomes they deliver for their patients, measured in part by quality measures,” the report states. “Primary care physicians who participated in the focus groups felt that current measures that focus on binary or strict cutoffs for individual diseases or screening tests are too simplistic and often fail to capture high-quality primary care.”
Potential solutions to the above financial challenges include sufficient upfront payments for primary care by models and ensuring that health systems transition value-based payments to frontline primary care practices. Solutions to the primary care workforce shortage include increased payments, increased support for primary care physicians, and investment in primary care trainees.
Primary care physicians expressed a belief that current performance measures could be improved by replacing condition-specific metrics with metrics that support access to and continuity of primary care, the report notes.
