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Moving in sync to value-based care

Organizations are more fully committing to value-based care. Discover what physicians need to succeed.

As value-based payments become the industry norm, the way physicians are compensated tends to be increasingly misaligned with how provider organizations are paid by public and private payers. The Health Care Payment Learning and Action Network (HCP-LAN) survey reveals that payments tied to value have increased from 23% in 2016 to 41% in 2021. Yet, the Deloitte 2022 Survey of US Physicians shows that during the same time period, the share of physician compensation has stayed the same with about one in four physicians receiving meaningful value-based performance bonuses.

Deloitte’s modeling to estimate the financial “tipping point” shows that when revenue from value-based payments reaches 40% of a provider organization’s overall revenue, it makes sense for that organization to fully transform to a value-based approach for all patients under its care.1 The HCP-LAN survey data suggests that, on average, the industry is close to this point. This means that for many provider organizations, a value-based care model has become more financially advantageous than the traditional volume-driven episodic model of care.

To correct this misalignment, provider organizations should rethink legacy physician compensation structures, so they are in sync with the organizations’ payment models that reward quality, outcomes, and equity. Additionally, they should provide physicians with the right capabilities:

  • people to provide appropriate care and enable everybody to practice at the top of their license (e.g., comprehensive care teams)
  • processes to ensure the right care is delivered in the right setting by the right people (e.g., care management programs)
  • technology and data to seamlessly operationalize new care models (e.g., automated workflows and point-of-care decision support)

While the industry hovers at this tipping point, now is the time to ensure that physicians are equipped to successfully transition to value-based care—and that the incentives at an individual level correspond with the incentives at an organization level.

About the analysis

 

Deloitte 2022 Survey of US Physicians
 

Methodology: The Deloitte Center for Health Solutions fielded a survey of 660 US-based primary care and specialty physicians from January to March 2022 to understand physician adoption and perception of key market trends.

Survey question: In the past 12 months, what percentage of your personal compensation came from bonuses or other incentive payments directly tied to achieving specified performance goals (e.g., quality-of-care scores, patient satisfaction scores, productivity improvements, or cost reduction)?

Response options: 5% or less, 6%–10%, 11%–15%, 16%–20%, 21%–25%, more than 25%, eligible for a bonus, but none received/paid, or not eligible for bonus.

Health Care Payment Learning and Action Network (HCP-LAN)

Methodology: HCP-LAN is a national effort to assess the adoption of alternative payment models (APM). HCP-LAN collects information from a large sample of public and private payers about payments made to providers, classifies those payments by category, and reports them in aggregate and by book of business. The Deloitte Center for Health Solutions plotted annual estimates for categories 3 and 4 APMs, which include APMs with shared savings and shared risk, and population-based management. We acknowledge that the aggregate trend in the HCP-LAN data can be driven by either an increase over time in the number of provider organizations participating in APMs or an increase in the share of payments tied to APMs for existing APM participants.

Data limitations: While we used industry-level estimates from the HCP-LAN survey as a proxy for how provider organizations are paid, this data cannot tell us how many organizations receive payments tied to value nor how those payments subsequently get distributed to individual physicians. Our physician survey data suggests that legacy physician compensation structures remain common.

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Acknowledgments

Project team: Natasha Elsner and Wendy Gerhardt led survey development and hypothesis generation. Hemnabh Varia oversaw the fielding, helped with the analysis plan and data interpretation. Our executive sponsors Ken Abrams, MD; Bill Fera, MD; Jay Bhatt, DO; and Shaun Rangappa, MD, provided guidance and reviews of multiple drafts.

The authors would also like to thank Grace Feldman, Danielle Moon, Meghna Sharma, Cassidy Estep, Lindsay Parra, Mark Snyder, Rebecca Knutsen, Prodyut Ranjan Borah, Laura DeSimio, Zion Bereket, Gargi Khandelwal and the many others who contributed to the success of this project.

Cover image by: Kevin Weier and Natalie Pfaff.

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