Why Primary Care Practitioners Aren’t Joining Value-Based Payment Models: Reasons and Potential Solutions

Abstract

• Issue: During the past 14 years, the federal government and states have fielded numerous value-based payment (VBP) models for primary care to move away from a fee-for-service payment model that incentivizes the delivery of more services over better-quality care. However, most primary care practitioners (PCPs) do not participate in VBP models, and the reasons are largely unknown.
• Goals: Learn the barriers PCPs face to participating in VBP models from those who have not joined them and identify potential solutions.
• Methods: Interviews with 12 PCPs in leadership positions and other primary care management experts and focus groups with 17 frontline PCPs with no prior participation in VBP primary care models.
• Key Findings and Conclusion: PCPs’ enthusiasm for VBP models is tempered by financial barriers, the PCP workforce shortage, and imperfect performance measures. Suggested solutions to the financial challenges 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 felt that current performance measures could be improved by swapping out condition-specific metrics for metrics that support access and continuity of primary care.

Introduction

The Centers for Medicare and Medicaid Services (CMS) and a number of states have introduced value-based payment (VBP) models focused on primary care since 2010. These models aim to incorporate more upfront and results-based payments to move primary care practitioners (PCPs) off the “hamster wheel” of fee-for-service payments that incentivize them to deliver higher volumes of services.¹ VBP models build on patient-centered medical home efforts² and share similar goals, such as strengthening the primary care infrastructure and improving patients’ access to high-quality care, to ultimately improve health outcomes and reduce unnecessary health care spending.³Several VBP models encourage collaboration across public and commercial payers to reduce reporting burden and incentivize care improvement by ensuring they include a high proportion of a PCP’s patients.

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