Health Plans

The value-based care crossroad: How health plans can remain on course

By Peter Manoogian, and Shruti Rangnekar

Sept. 29, 2019 | Article | 2-minute read

The value-based care crossroad: how health plans can remain on course

In recent months, we’ve talked about the current state of value-based care (VBC). Primary care providers (PCPs) have told us they’re familiar with the concept of VBC and have reported moderate participation levels in it, but PCPs also tell us they’re frustrated and confused about the details of these programs and don’t feel that they’re impacting how they practice medicine.


The bottom line is, while a transformation to payments based on cost and quality is happening, the corresponding behavior shift in care delivery is either not happening or, at best, is lagging far behind. Health plans are working hard to drive value-based care forward. Yet, according to our recent research, provider satisfaction with health plan VBC contracts is mediocre at best. Health plans are not meeting the support needs of providers who are often juggling multiple VBC contracts simultaneously.


Why are providers finding the transition from traditional fee-for-service to newer value-based care models to be such a bumpy road? To find out, we conducted a national survey of 1,019 PCPs to focus on their experiences with VBC programs.


Across the board, PCPs told us they’re struggling to succeed or lack the interest and engagement required to achieve true clinical transformation. The good news? Health plans can drive stronger engagement by working through four categories:

  1. Awareness: To succeed in VBC programs, PCPs must first understand what VBC is and what these programs entail.
  2. Interest: Health plans should design programs in a way that motivates PCPs to participate by mitigating common barriers. The PCPs we surveyed reported unrealistic goals, overly complicated metrics and risk aversion as the three biggest barriers to participation.
  3. Support: While health plans are making efforts to support PCPs, their one-size-fits-all approach is missing the mark. To provide effective support, health plans must identify the needs of subsets of the population and provide tailored support accordingly.
  4. Advocacy: For VBC programs to truly thrive, they need to be built on a foundation of partnership between health plans and providers. Giving PCPs a voice will help health plans adapt programs and support mechanisms to PCPs’ changing needs.

Providing the right forms of support is the key to engaging PCPs in VBC, and PCPs are looking for this involvement from health plans. Ninety-two percent of PCPs surveyed want health plan support in the transition from volume to value. PCPs who feel supported by their plans are 10 times more likely to say that their VBC programs are highly impactful to how they practice medicine. In fact, a deeper dive into the way surveyed PCPs prioritize VBC program elements reveals that health plan support has the highest derived importance for PCP satisfaction.


To learn more, check out our new white paper, “A Transition in Flux: How Health Plans Can Optimize Value-Based Care Initiatives” and infographic, “The Keys to Enhancing Value-Based Care” for details on the survey results, how health plans can increase PCP engagement and the next steps health plans can take to build successful VBC programs.

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