Doctors Feel Excluded from Health Care Value Efforts, Survey Shows

Physicians understand the financial challenges, but many don’t think they are in a position to help rein in health care rising costs.

U.S. hospitals and health care groups have experimented over the past decade with new management structures and alternative payment models to provide quality health care at lower cost. But physicians have been slow to embrace these for a host of reasons. Chief among them, our research shows, is that they feel excluded from the process.

The only practical way to make value-based care a reality is for health care organizations to bring physicians back into the decision-making process.

With our colleagues at Bain & Co., we recently surveyed  980 U.S. physicians as well as 100 health system procurement officers — the people in charge of buying supplies for hospitals. What we found was startling: Physicians clearly understand the challenge posed by rising costs for clinical care and prescription drugs, but many don’t feel they are in a position to help rein in costs. Rather, they do not feel sufficiently engaged in making important decisions about cost control, performance improvement and adoption of new reimbursement models.

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By sidelining doctors, the health care industry has overlooked a key principle in change management: Physicians who are not aligned and engaged with their organization have more reasons to resist new systems, while those who are engaged in decision-making are much more satisfied with the working environment and willing to lead change.

Physicians are particularly hesitant to embrace new systems when the clinical implications and the return on investment are unproven and the administrative burden is significant. More than 70 percent of physicians told us they prefer the traditional fee-for-service payment model, citing concerns about the complexity and quality of care associated with value-based models.

The evolving role of physicians in the purchase of medical equipment, however, highlights the kind of collaborative approach to decision-making that could help create a more supportive climate for value-based care. Many hospitals in the United States have recently been giving surgeons a bigger say in medical-equipment purchasing. More than 80 percent of surgeons and procurement officers told us they now work in collaborative partnerships to purchase medical equipment, weighing clinical and economic value together, and surgeons broadly support this arrangement.

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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 percent vs. minus-61 percent) between those who said they were highly engaged in decision-making and those who were not.

Health care organizations can generate greater support for value-based care by working closely with their physicians to shape these models and addressing doctors’ concerns about implementation and outcomes. It will take time to develop clinical and economic evidence, which means the pace of change will remain slow. But it will also help the industry move toward better solutions.

Tim van Biesen is a partner in Bain & Co.’s health care practice. Josh Weisbrod is a partner in Bain & Co.’s health care practice.

Copyright 2017 Harvard Business School Publishing Corp. Distributed by The New York Times Syndicate.

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