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Despite Value-Based Rhetoric, Fee-For-Service Still Dominates Healthcare

By Philip Betbeze  
   July 16, 2018

A survey of physicians and health plan executives shows progress on the path toward value-based care has stalled and that health IT is a hindrance.

More than three months ago, in his "no turning back" speech at an industry conference, Health and Human Services Secretary Alex Azar highlighted four ways the Trump administration planned to continue toward transforming the healthcare system to one focused on value rather than volume.

But that progress appears to have stalled, and may have even reversed, according to a survey of physicians and health plan executives from Quest Diagnostics.  

Among the findings:

  • More than two thirds of respondents (67%) say they believe the U.S. has a fee-for-service system versus a value-based care system (27%). That actually represents a decline from last year's study, when those numbers were 63% and 29% respectively.
     
  • Some 57% of health plan executives say they now believe physicians don't have the tools to succeed in value-based care, up from 45% last year.
     
  • Only 39% of physicians say electronic health records provide all the data they need to care for their patients.
     
  • Some 80% of health plan executives say they believe investments made in technology for quality initiatives have improved the value of healthcare for patients, but only 68% of physicians agree.
     
  • Only 55% of physicians believe putting more emphasis on a consumer-based approach to healthcare will help advance value-based care, while 75% of health plan executives believe it will.

The study, "Stalled Progress on the Path to Value-Based Care," of 451 primary care physicians and health plan executives, suggests that despite the pessimism, both physicians and health plan executives agree that better alignment between the two groups is necessary to accelerate the transition, and that technological improvements will be necessary to achieve it.

But curiously, neither group is increasing investment in new health information technology. They are more interested in optimizing the tech they currently possess, and interoperability is a key impediment. Among physicians and health plan respondents combined:

  • "Making large health IT infrastructure investments" fell from 15% in 2017 to 11% in 2018.
     
  • "Investing in some new health IT" fell from 34% to 25%.
     
  • "Optimizing existing health IT" rose to 53% from 38%.

“Measures that optimize EHRs, make data more accessible and insightful, and reduce complexity of quality measurement are much needed steps to accelerate this transition," said L. Patrick Hames, MD, Quest Diagnostics' chief clinical officer, in a release.

Indeed, physicians and health plan respondents said the top two barriers to accelerating health IT adoption included incompatibility between systems (26%) and frustration that adopting health IT meant more work with little or no benefit (22%).

Philip Betbeze is the senior leadership editor at HealthLeaders.


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