How Value-Based Care Affects Providers

As a primary care physician, I’ve seen my fair share of patients who, after switching from a fee-for-service model to our value-based care model, see remarkable long-term improvements in their health. My father’s experience is a great example.

When he joined ChenMed several years ago after retiring, he had been seeing a variety of specialists for back pain, memory loss, diabetes, and his heart. His new primary care doctor, after taking a comprehensive history and doing a thorough exam, shared a theory about why my dad seemed to need so much specialized health care. The doctor had asked my father about his sleep habits, and it turned out that he’d been sleeping on the same mattress for 20 years.

On the doctor’s advice, Dad invested in a new one, and within a couple of weeks my father’s life changed. His back pain went away, and his memory returned to normal once he started sleeping better. He was able to remember to take his prescribed heart medications every day. Through basic bloodwork, his doctor noted that he was just barely diabetic, and the level of management my dad had been recommended before wasn’t indicated. He’d even been seeing a gastroenterologist, simply because his previous doctor had referred him. It turned out that wasn’t necessary either. All of this happened because at ChenMed, where our primary care doctors have very small/intimate patient panels, we have the time to listen. That is the fundamental core of the doctor/patient relationship.

And this experience isn’t unique to my family. Each day, thanks to the high-touch, low-volume approach that is the bedrock of value-based health care, my colleagues and I get to practice medicine the way it should be practiced — resulting in healthier patients and happier doctors.

What value-based reimbursement means in health care

In the fee-for-service payment model, doctors are compensated based on volume of care — how many patients they can see, how many tests they order, how many prescriptions they write. An October 2019 JAMA study found that approximately 20–25% of health care spending in the U.S. is wasteful, with three main factors being administrative costs; prices, primarily due to high costs for brand-name drugs; and inefficient and low-value health care, which not only wastes money but often results in poor outcomes for patients. 

Value-based payment models are based on well care for patients: better everyday health and fewer hospital visits. These payment models are proven to result in better outcomes, quality of care, and patient satisfaction. And because value-based care emphasizes preventive health care, it cuts down on unnecessary imaging and tests, the potential for medical mistakes, and costly visits to the ER.

ChenMed’s value-based model

Within value-based payment are three risk levels. These range from no provider risk to full provider risk. At ChenMed, a full-risk provider, we work with Medicare Advantage, which transfers all risk from the government to private insurance companies. We then partner with those insurance companies and transfer all of the risk to us, which is why we are considered an accountable care organization.

Our patients are elderly, with an average age of 72. Most have multiple chronic conditions and live on a fixed income. Our full-risk model lets us address causes of symptoms, which makes us rare among providers. With our physician-led, team-based approach, we work closely with our patients to understand and address social determinants of health — such as food and housing security, financial ability to pay for medications, and access to transportation, what we call “the causes of the causes” — which can have a dramatic impact on the health of our patients.

When it comes to patient care, we are responsible for our patients at every step, from outpatient care to an ER visit or hospitalization. By putting a big emphasis on preventive care, we aim to keep their chronic conditions in check. While that’s the right thing to do for moral reasons, and what drove must of us to enter medicine in the first place, it’s also the key to our compensation: In our world of value-based care, our doctors are financially rewarded based on our patients’ health outcomes.

Value-based care impacts on health care providers

Studies show that up to half of physicians experience some level of burnout. A main driver is the time pressures imposed by fee-for-service care. The sheer volume of patients physicians must see — the average U.S. panel size is 2,300 patients — plus the documentation required afterward means that patients often don’t get much face time with their physicians (on average just about 15 minutes). It’s easy to see why so many primary care physicians in this system feel drained of purpose.

In value-based care, especially our model, doctors are only looking after a few hundred patients. At ChenMed, the average is under 400, and the maximum allowed is 450. We follow up with our patients routinely on a monthly basis, spending on average about 200 minutes per patient, per year. This gives us the valuable time we need to build the doctor-patient relationship. 

And that’s the real secret: Building relationships with our patients improves their trust in us, meaning they know to call us if something is off. This often results in us being able to spot — or manage — a health concern before it becomes a full-blown problem, with complications.

Even without the infection risks posed by COVID-19, it’s particularly important to keep the elderly out of the hospital if we can, since many struggle with physical and mental deterioration during their hospital stay, making recovery much more difficult. If one of our patients does get admitted to the ER, we get a notification. Our doctors call the hospital and ask to speak to an ER physician on duty. If the patient is stable and it’s something we can handle in outpatient care, we can send a ride-share car to pick up the patient at the hospital and transfer him or her to our office.

The bottom line is that value-based care means you get to change the lives of your patients — to provide them with the best quality of life we can. That’s what I look forward to every day.

Change how you practice medicine. Learn more about how the value-based care model works at ChenMed.