By Emma Freer
Originally published by Texas Medical Association on January 11, 2023.
The shift from fee-for-service to value-based care is underway, with public and private payers introducing myriad new payment models in recent years. But many physicians find the variety of plans overwhelming, and the investments necessary to support them challenging.
To help clear these hurdles, the Texas Medical Association Board of Trustees approved last May the formation of a Task Force on Alternative Payment Models (APMs). Over the next two years, its diverse membership – which spans specialties, experience levels, practice types, and geographic regions – is charged with reviewing value-based care trends, prioritizing members’ needs, and serving as a touchstone of APM policy and activity.
Norman Chenven, MD, founding CEO of Austin Regional Clinic (ARC) and co-chair of the task force, commends TMA for convening the group. He brings with him more than four decades of experience working with APMs, dating back to health maintenance organizations in the early 1980s.
“It’s great for TMA to develop resources for physicians adapting to the inevitable challenges of these changing payment models,” he said.
Under a value-based care model, physicians and other healthcare professionals are paid based on the quality of patient outcomes rather than the quantity of services provided.
The Centers for Medicare & Medicaid Services (CMS) has a stated goal of transitioning all Medicare patients to value-based care arrangements by 2030. In the meantime, it continues to test initiatives such as the Enhancing Oncology Model and the Bundled Payments for Care Improvement Advanced Model. CMS also continues to address various issues, such as how to incentivize collaboration between primary care physicians and specialists.
David Fleeger, MD, a colon and rectal surgeon in Austin, co-chair of the task force, and past president of TMA, says he expects private payers to follow CMS’ example.
Although value-based models have grown more common, uptake remains slow. In a 2020 survey, the Deloitte Center for Health Solutions found 97% of physician respondents still relied mostly on fee-for-service payments, with roughly a third drawing a portion of their compensation from value-based payments. Moreover, less than a quarter received incentive payments of more than 5%.
Kim Harmon, TMA’s associate vice president of innovative practice models, says value-based care can prove daunting because of its breadth of applications, from public and private payers to every kind of physician practice. It’s also difficult to identify which physicians participate in value-based arrangements because payers aren’t required to share such information.
With these challenges in mind, the task force hopes to empower Texas physicians to implement value-based care by offering support and sharing institutional knowledge from early adopters.
Dr. Chenven, for instance, can speak to the start-up costs that come with participating in value-based models. At ARC, his multispecialty group, these included investments in staff and information technology to ensure patients received preventive care and kept up with chronic care.
“No individual office or small office is going to have those resources,” he said. “There has to be collaboration across [physicians] in the community.”
The task force also can push CMS and private payers to develop APMs that are more accessible to a wider range of specialties and practice types, Dr. Fleeger says.
“We need to make sure that whatever gets done raises all boats,” he said.
The task force next meets later this month, when it will begin identifying and prioritizing TMA member physicians’ needs for education and other resources related to APMs.
Dr. Chenven says this is a critical first step to demonstrate the value in value-based care to physicians.
“It represents a huge culture change. It’s a change in the business model of medicine, and change is always hard,” he said. “So, you need thoughtful preparation to make it go smoothly.”