Study Asks PCPs Why They Avoid Value-Based Payment Models

The Commonwealth Fund has published the results of a study seeking to understand why more primary care practitioners (PCPs) are not participating in value-based payment (VBP) models.

After conducting focus groups with PCPs who have not participated in VBP models and interviews with primary care executives and association leaders, the report offers some recommendations about how to improve PCP participation. 

The report notes that during the past 14 years, CMS and states have tried several VBP models for primary care, but most PCPs still do not participate in VBP models, and the reasons are largely unknown. (A 2022 survey found that just 46 percent of primary care physicians reported receiving any value-based payments. Smaller, independent, and less-resourced practices that serve 39 percent of traditional Medicare beneficiaries are the least likely to apply to VBP models.)



Summarizing what they heard from focus group and interview participants, the report’s authors noted that PCPs’ enthusiasm for VBP models is tempered by financial barriers, the PCP workforce shortage, and what they perceive to be imperfect performance measures. 

On the financial and resource front, here is one example from the study: Some health systems participating in VBP models are not providing frontline PCPs or practice sites with the resources necessary to carry out the model requirements. One expert said health systems are “using their contracting authority to [join a model] on behalf of those doctors but not reliably transmitting those resources to the primary care practice.” For example, two PCPs said that, when they asked for more nurses at the practice sites, the health system hired a nurse but seated her at the corporate office. An expert who works with primary care practices across health systems said system-owned practices that do well in VBP models transfer resources to support care delivery changes at the practice sites.

In the quality measurement realm, PCPs expressed concern about documentation burden as well as fears that the current quality measures used in VBP models impede their ability to deliver high-quality care. “Value-based payment models tie the amount healthcare practitioners earn for their services to the results they deliver for their patients as measured in part by quality measures,” the report said. “PCPs in the focus groups felt that current measures that focus on binary or stark cut-offs for individual conditions or screening tests are overly simplistic and often fail to capture high-quality primary care.”

Possible solutions to the financial challenges mentioned include sufficient upfront primary care payments from the models and ensuring health systems transfer the value-based payments to frontline primary care practices. Solutions to the PCP workforce shortage include increasing payments, boosting supports for PCPs, and investing in primary care trainees.

PCPs expressed a belief that current performance measures could be improved by swapping out condition-specific metrics for metrics that support access and continuity of primary care, the report said.