At the risk of restating the obvious, physicians and clinicians are at the heart of payer value-based care arrangements and absolutely vital to their success.
With value-based care expected to account for 59 percent of healthcare payments by 2020, according to the Aetna 2019 Health Care Trends Report, and even more for large health plans like United, payers are increasingly dependent on physicians and invested in their well-being.
So first, the good news:
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- Physician Burnout: 9 out of 10 payers believe they have a role to play in reducing physician burnout.
- Physician Satisfaction: More than one-third of payers (34 percent) can point to specific actions they have taken and more than half (54 percent) are creating plans to improve physician satisfaction.
- Prior Authorization: Nearly two-thirds (58 percent) say they're providing tools to physicians and providers to more easily obtain prior authorizations, up from 41 percent a year ago. This number jumps to 69 percent for large payers (5,001+ employees).
- Quality: Payers also report improvement in another value-based care pain point for physicians – aligning reimbursement and quality improvement data to individual providers – with a year-over-year jump from 34 to 45 percent.
Large payers report even more success in addressing physician burnout. 58 percent say they are effectively improving physician satisfaction compared to 36 percent of small payers.
As the organization that created the Physician Misery Index to galvanize the healthcare industry to come together to remedy alarming rates of physician dissatisfaction, it is encouraging to know payers are taking steps to reduce physician frustrations.
And now, the not-as-good news: as we've said before, there's more we all can – and should do – to improve physician satisfaction and the ability of physicians to succeed in value-based care.
A HIMSS Media survey to help understand how payers are leveraging data to advance value-based care found health plans are missing data-driven opportunities to help physicians succeed in these reimbursement models.
On the positive side, two out of three payers report they are sharing pharmacy data, medication adherence data and risk scores. Two-thirds say they are extremely or very effective at helping value-based care providers flag high-cost conditions among members.
Yet, the survey also revealed less than half of payers are taking the following actions to help physicians achieve value-based care success:
- Providing access to risk-assessment data/analytics to better manage population health (46 percent)
- Sharing longitudinal claims information (43 percent) and social determinants of health (SDoH) data (38 percent)
- Providing access to risk-assessment data/analytics to better identify and manage rising-risk members (36 percent)
- Creating/managing programs to address SDoH (35 percent)
- Providing access to multi-payer population health management tools (28 percent)
Similar to physician satisfaction, there are differences between large (5,001+ employees) and small payers. For example,
- 47 percent of large payers are providing population health consultants to help identify high-risk and rising-risk patients compared to 27 percent of small health plans.
- 71 percent of large plans report success in improving collaboration and alignment around shared cost and quality goals versus 38 percent of small payers.
The survey shows payers are increasingly helping providers succeed in value-based care by focusing on physician burnout, improving prior authorizations and providing data and population health tools – and that there's more they can do.
Payers can help reduce burnout and improve physicians' ability to succeed in value-based care. Learn how you can be part of restoring physicians' joy of medicine.
Click to enlarge the infographic.