The trend towards replacing fee-for-service (FFS) medicine with value-based alternatives—ranging from case rates to full at-risk capitation—is gaining momentum. There is a growing belief that making healthcare providers financially responsible for achieving quality outcomes is the best way to control healthcare costs in a politically acceptable manner.

Transforming physician behavior is central to achieving lasting changes in practice patterns as the risk for outcomes shifts from payers to providers. Physicians, who have thrived in the FFS model, need a focused process to understand how their approach to patient care must adapt for success in an at-risk environment.

Establishing Essential Linkages

To achieve meaningful change, it is crucial to establish connections:

• Between primary care and specialty physicians

• Between physicians and hospitals

• Between care providers and payors

• These linkages are vital for success in a prepaid, at-risk environment.

Key Success Factors

Robust Use of Data:

Accurate and detailed data is essential. Physicians respond well to data when it is credible and meaningful. Data integrity is paramount; any perceived flaws can quickly erode trust and motivation.

Willingness to Review Medical Records:

Ensuring data integrity may require reviewing patient charts in a positive, constructive, and neutral environment. This process helps build consensus about past events in a non-punitive context. Physicians play a crucial role in this process

Commitment to the Process:

Changing practice patterns is akin to managing a chronic disease; it requires ongoing development, not just a one-time training session. The first two steps—data integrity and chart reviews—must be repeated until physicians fully own the outcomes. This intensive process creates physician champions who can convert new participants and ensure steady progress.

Understanding the Audience:

Change must be communicated effectively not only to healthcare practitioners but also to the Directors of the organizations that fund it. Often, these Directors are laypeople who may not fully understand the complexities of healthcare delivery and financing.

If your organization or client is considering or embarking on the transition from FFS payment to some form of at-risk or value-based compensation and needs guidance from a physician with a proven track record in this area, please do not hesitate to contact LG Medical Consulting.