It was fascinating to read a new issue brief from the New York-based Commonwealth Fund published August 5, on primary care providers’ (both primary care physicians’ and mid-level practitioners’) perceptions of new payment models in healthcare.
The Commonwealth Fund, a “private foundation that aims to promote a high performing healthcare system that achieves better access, improved quality, and greater efficiency, particularly for society’s most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults,” had issued the brief, entitled “Primary Care Providers’ Views of Recent Trends in Health Care Delivery and Payment,” based on a survey of 1,624 primary care physicians and 525 mid-level clinicians (nurse practitioners and physician assistants).
The abstract to the issue brief notes that “A new survey from The Commonwealth Fund and The Kaiser Family Foundation asked primary care providers—physicians, nurse practitioners, and physician assistants—about their experiences with and reactions to recent changes in health care delivery and payment. Providers’ views are generally positive regarding the impact of health information technology on quality of care, but they are more divided on the increased use of medical homes and accountable care organizations. Overall, providers are more negative about the increased reliance on quality metrics to assess their performance and about financial penalties. Many physicians expressed frustration with the speed and administrative burden of Medicaid and Medicare payments. An earlier brief focused on providers’ experiences under the ACA’s coverage expansions and their opinions about the law.”
The core findings of the survey were that primary care physicians, far more than mid-level practitioners, expressed considerable skepticism about the new healthcare delivery and payment models, in particular the two that were asked about specifically—accountable care organizations and patient-centered medical homes; though those PCPs who had worked under ACO or PMCH arrangements were far more likely to agree that they offered the potential for improving the quality of care delivery to patients being cared for under those types of arrangements.
As to why a strong plurality of primary care physicians have negative perceptions of the potential for the value-based outcomes measures embedded in ACO and PCMH arrangements to improve quality and efficiency, Melinda Abrams, The Commonwealth Fund’s vice president for delivery system reform, told me, “To be honest, we don’t know why they don’t like the quality measures; we only know there’s a fair bit of dissatisfaction with the quality measures. When we asked physicians whether they thought the increased use of quality measures was impacting their ability to provide high-quality care, 50 percent were negative on that, and only 22 percent were positive. We also asked, are you receive quality incentive-based payments? That reflected the entire group, but even among those receiving incentive payments based on quality, 50 percent felt it was negative, and only 28 percent felt it was positive.”
Still, as the issue brief’s abstract noted, “The survey results indicate that primary care providers’ views of many of these new models are more negative than positive. There are exceptions: health information technology gets mostly positive views and medical homes receive mixed opinions with a positive tilt. With regard to HIT, our study indicates that primary care providers generally accept the promise of HIT to improve quality of care even if previous research shows they dislike the process of transitioning from paper-based records.8 Our survey results also may reflect clinicians’ earlier exposure to certain models and tools. National adoption of electronic health records received a boost from the Health Information Technology for Economic and Clinical Health (HITECH) Act of the federal stimulus package of 2009, while the four primary care specialty societies announced a joint statement regarding medical homes in February 2007, several years before passage of the Affordable Care Act.”
“Our results show that 50 percent of primary care providers say that healthcare IT is improving the quality of care they provide,” Abrams told me. “And what we’ve learned from other studies is this: other studies have found that providers generally accept the promise of HIT as a concept, even as they dislike the process of transitioning to electronic from paper. Our specific question was on the impact of their ability to provide high-quality care to their patients. It’s a more general question than about the transition. We weren’t asking about the transition. So half of physicians and two-thirds of mid-level providers see the advance of health IT as having a positive impact,” she noted.
What is inevitable is that clinicians, but most especially primary care physicians, will be demanding a great deal from the clinical and other information systems that are being implemented now to facilitate accountable care, population health management, and patient-centered medical home-based care.
As Abrams put it to me, “There’s nothing in the survey findings that would indicate that increased success with IT would improve their views of ACOs and medical homes; our findings don’t show that. But I would suspect that, to fulfill the promise of ACOs and PCMHs requires ease of use of IT and the data from that technology, the more they learn to use technology effectively to optimize patient care, yes, I believe they will become more positive about ACOs and patient-centered medical homes, yes. And more pieces will help them embrace ACOs and PCMHs.”
So such interpretations of survey data only help to reinforce what seemed apparent already: that healthcare IT leaders are facing a gigantic opportunity/risk proposition ahead of them, when it comes to clinical and other information systems supporting accountable care and population health management. Physicians, and primary care physicians in particular, are looking to those systems to carry them to the “promised land” of greater clinical effectiveness and practice efficiency, and to help them master the intricate challenges of succeeding in carrying out risk-based contracting in a high-pressure, high-stakes environment.
And this is in an environment in which we all know that the IT solutions offered by vendors, both major and smaller, still leave some things to be desired, and that tremendous amounts of customization are being required to make population health, analytics, clinical decision support, and other systems needed to make pop health and accountable care work, are being poured into those systems.
So the next few years inevitably are going to be filled with tension for healthcare IT leaders, as healthcare IT professionals work to get all the foundations, and the details, right, with those systems. But the light at the end of the tunnel is this: that, as primary care physicians become adept at using the increasingly-adept solutions that will be applied to population health- and accountable care-based clinical practice, primary care physicians’ perceptions not only of those tools, but of value-based care delivery and payment itself, will get better over time. And that will definitely significant for all of us, as we pursue the new healthcare in earnest.
