Value-based care stalled by insufficient tools and data, study says

Value-based care is the future that hospitals, health insurance companies and policymakers have all been driving toward for several years. But that horizon appears to be no closer than it was 12 months ago. 

Physicians and health plan executives agreed that healthcare has made little progress toward value-based care since last year -- 67 percent of physicians and health plan execs said the U.S. still has a fee-for-service system, according to new research commissioned by Quest Diagnostics.

Last year, 63 percent said they believe the U.S. has a fee-for-service system, suggesting that efforts to switch to a value-based framework may have taken a step backward.

The findings point to physicians' lack of tools and insufficient information about their patients as possible reasons. Other barriers include a continuing misalignment of the perceptions of physicians and health plan executives regarding the usefulness of quality metrics and technology in providing patient care.

Fifty-seven percent of the 451 participating health plan executives agreed that physicians do not have the tools to succeed under value-based care, an increase of 12 percentage points since the 2017 study. Meanwhile, nearly three-quarters of all respondents said physicians do not have all the information they need about their patients, another 12 percent increase. And only 39 percent of physicians said electronic health records provide all the data they need to care for their patients.

There also seems to be some misalignment between physicians and health plan executives around quality metrics and technology. When asked "How strongly do you agree or disagree that investments made in technology for quality initiatives have improved the value of healthcare for patients," 80 percent of health plan executives agreed, compared to only 68 percent of physicians. What's more, 62 percent of health plan executives said we've made progress toward alignment between payers and providers, but only 41 percent of physicians agreed.

Despite that gap, there was some consensus when it came to tools that might help the value-based care situation. 

More than six in 10 of participating physicians and health plan executives, in fact, agreed technologies such as bioinformatics, artificial intelligence, the SMART App Platform, FHIR (Fast Healthcare Interoperability Resources) and machine learning have potential to improve value-based care -- while 64 percent of health plan executives said one advantage of blockchain in healthcare is that it can promote shared data across organizations to surmount interoperability.

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com