The only practical way to make value-based care a reality is for healthcare organizations to take physician voices seriously in decision-making processes, writes Tim van Biesen and Josh Weisbrod for HBR.
In a recent survey conducted in partnership with Bain & Company of 980 U.S. physicians across eight specialties, HBR found that physicians express a clear understanding of the challenges posed by rising costs for clinical care and prescription drugs. However, many doctors don’t feel that they are in a position to help rein in costs and are not convinced that their participation in value-based care-focused efforts will make a difference.
Why Doctors Feel Overruled
In the study, doctors expressed feeling excluded from value-based care efforts because they don’t feel in control of the factors comprising the metrics by which they’re judged. These factors include cost control, performance improvement, and adoption of new reimbursement models. According to the the HBR piece, “many feel overruled, with mandate after mandate from hospitals and management-led health organizations being done to them, not with them.”
Successful organizations know that provider engagement is key. “Engaging dyad leadership is critical,” says Jim Sams, MD, CEO of Privia Medical Group – Georgia. “Physicians are well-versed in clinical logic, but we don’t have all the necessary business logic. An aligned clinical/business leader dyad makes sense because each member is a critical contributor to the next level of the organization’s success.”
What Physicians Want: Patient-Focused Care
According to HBR, “physicians staunchly resist new approaches that could put patient care at risk. That helps explain why management-led organizations that have not fully embraced physician input… have run into resistance or have failed to make a greater impact.”
Dr. Shashank Patel, a member of Privia’s engagement committee, agrees. “From a doctor’s perspective, medicine has become less about the doctor-patient relationship and more about chasing and entering data and metrics rather than dealing with the person in front of you telling you what’s wrong with them,” says. “To keep us engaged, we have to be able to maintain that relationship.”
How Some Physicians are Making Sure They’re Heard
Dr. Patel and seven other physicians make up the engagement committee, a small group of Privia Medical Group providers who meet monthly to discuss and address Privia’s physician engagement concerns across the organization. Dr. Patel finds value in meeting regularly with his colleagues to share anecdotes and overcome challenges as a group. “It’s about getting as much information as possible to measure engagement and comparing yourself to your peers. We’ve found that exposing ourselves to strategies from more successful physicians only helps to improve our level of care. We’re comfortable with growth and change that puts our patients at the center of our decision-making process. Ultimately, our interest is in improving the delivery of care to our patients.”
In addition to the engagement committee, Privia receives physician feedback from its POD (physician organized delivery) meetings. All Privia Medical Group physicians participate in geographically localized PODs to organize themselves in population health programs, payer contracts and many other clinical and business related initiatives. These Privia groups were created with the recognition that healthcare is local and physician-led.
“The meaty stuff is shared at POD meetings; how do we get value out of the data in [our] reports? How can those reports be structured in a way that we can easily review and track and change our metrics? Data are delivered monthly to physicians for review & discussion so everyone becomes well-versed in population health and value-based care,” says Patel. He emphasizes that the solutions to challenges are created for physicians, by physicians. These decisions have direct ramifications for compensation, patient attribution, performance, and engagement.
By incorporating physician voices and concerns, Privia brings providers into the fold so they’re not only prepared, but personally invested in the shift to value-based care. The result is a more engaged group of doctors. POD meetings have received an 86% attendance across all PODs in a single month. Perhaps as a testament to the power of engagement, according to 2017 Privia Provider Engagement Survey, which measures overall levels of engagement and satisfaction within the medical group, Privia physicians scored a net promoter score of 70 among providers who have been with Privia for longer than 2 years, higher than Amazon’s 69. Nearly half of all Privia physicians would recommend Privia to a colleague.
These findings are in accordance with HBR’s, which found that “giving physicians a greater say increases their commitment to change. When we asked physicians if they would recommend their organization as a place to work and practice, we found a 108-point difference (+47% vs. -61%) between those who said they were highly engaged in decision making and those who were not.”