Primary Care Staffing Models Should Evolve Amid Shift to Value-Based Care

Providers with higher-level skills in their staffing mix aren't necessarily more productive than those that rely exclusively on medical assistants.

The optimal staffing model for a primary care clinic that remains focused on fee-for-service reimbursement differs from the optimal setup in a value-based context, according to a Premier white paper published Thursday.

That suggests clinics will have to reevaluate and tweak the composition of their clinical care teams as they explore the possibility of taking on more risk for the patient populations they serve—a balancing act that the industry's forward-thinking executives have already undertaken.

Twenty-two percent of family medicine clinics use a staffing model that relies exclusively on medical assistants (MA), according to the white paper, which studied 257 family medicine and primary care practices with more than 885 providers and 1,445 staff members. Fifty-four percent of the clinics were staffed with a combination of MAs and either registered nurses (RN) or licensed practical nurses (LPN), while another 24% were staffed with MAs, RNs, and LPNs, according to the Premier report.

Providers with a higher skill mix among their staff members didn't necessarily exhibit higher levels of productivity, as measured in work relative value units (wRVUs). The most productive clinics often had higher numbers of support staff per provider, according to the report.

"Higher skill mix models that are not using their staff to better coordinate and manage care may be contributing to a higher cost of care," Premier Vice President of Physician Enterprise Services Chris Smedley said in a statement. "As the industry moves toward value, participating in risk-based models will become a more viable option for many to ensure financial success. Providers will need to layer on staff with more specialized skill sets in order to more proactively address patient needs in value-based models."

"The key," Smedley added, "is to appropriately evolve staffing models as organizations shift to managing the health of their populations."

What this means is physician practices should invest intentionally in staffing models that will directly support the practice's shift from volume to value, according to Premier's report. A model that relies exclusively on MAs may make the most sense for fee-for-service providers. Those moving "further along the value chain," however, will likely need a higher skill mix.

"Value-based arrangements are more challenging and require very specific clinical, technical and administrative capabilities," the report states. "For example, pharmacist support, behavioral health providers, nutritionists and social workers are key to supporting community services. Moreover, patient education, care planning and coordination of care for the highly complex or vulnerable populations will further improve efficiency and effectiveness in a value-based payment model."

"The challenge," the report adds, "is determining the readiness for building the right value-based model that can successfully assume and manage greater levels of risk."