Less than Half of Primary Care Physicians Participate in Value-Based Care

Value-based care participation is lacking among primary care physicians; most practices reported receiving fee-for-service payments in 2022, according to data from the Commonwealth Fund.

Value-based payment models have become more common in the healthcare industry over the last few years, but little is known about their use in the primary care sector.

The 2022 Commonwealth Fund International Health Policy Survey of Primary Care Physicians shed light on how primary care physicians are paid and the characteristics associated with value-based payment participation. The survey reflected responses from more than 1,000 US physicians.

The data revealed that more primary care physicians receive fee-for-service payments than value-based payments. Specifically, 71 percent of respondents said their practice received fee-for-service payments, while 46 percent reported receiving value-based payments.

Around 30 percent of primary care practices reported receiving shared savings or capitated payments.

Fee-for-service is likely the dominant payment model in primary care because value-based payment requires significant upfront investments that some underfunded primary care practices cannot afford, researchers wrote. In addition, small or independent primary care practices may struggle with the financial risks and potential losses associated with value-based care.

Value-based payment participation was more common among primary care practices with five or more physicians, those part of a large health system, or those in suburban or urban areas. Practices with more resources are likely to be more prepared to manage financial risk and invest in the staff and technology necessary for value-based care participation.

Value-based care participation was associated with additional efforts to improve care quality. For example, practices receiving value-based payments were more likely to report participating in accountable care organizations (ACOs) (66 percent versus 24 percent) or patient-centered medical homes (53 percent versus 30 percent).

Practices participating in value-based models were also more likely to report screening patients for social drivers of health (66 percent versus 60 percent), which can help address social needs that influence clinical outcomes.

“This association could indicate that PCPs who strive to improve the quality of their care are also more ready to engage in new types of payment. It also could mean that changing how we pay for care is enabling providers to offer more comprehensive, higher-quality care,” researchers wrote.

Policymakers and health plans could offer upfront financial assistance to encourage value-based payment participation among small, rural, and independent primary care practices. Additionally, policymakers could implement tailored support and technical assistance for practices and work with physicians to identify barriers to value-based care participation.

As the industry shifts to value-based payment models, more work must be done in the primary care sector to help boost participation.

A report from Chartis Group found that 69 percent of primary care physicians participated in an alternative payment model. However, only 21 percent of surveyed physicians were in a partial- and/or full-risk capitation agreement, marking them as value-based care “Leaders.”

Furthermore, data from MGMA revealed that just 6.74 percent of total medical revenue at primary care practices could be attributed to value-based payments.