webinar summary How Doctors Lead in Creating Value-Based Health Care Featuring Tim van Biesen and Josh Weisbrod February 20, 2018 sponsored by
webinar summary How Doctors Lead in Creating Value-Based Health Care Presenter: Tim van Biesen, Partner, Bain & Company Josh Weisbrod, Partner, Bain & Company Moderator: Gardiner Morse, Senior Editor, Harvard Business Review Overview In recent years health care organizations have seen a marked slowdown in the adoption of valuebased payment models. A key reason is physician hesitancy to embrace these models. Many doctors want clear clinical and economic proof that value-based payment models will maintain health care quality, while simultaneously reducing costs. Without this information, physicians often dig in their heels and cling to traditional fee-for-service models. Engaging doctors in organizational decisionmaking processes is a proven way to empower this critical group. This approach makes it easier to implement new management structures. Context Tim van Biesen and Josh Weisbrod shared insights from Bain & Company research about why many physicians feel excluded from value-based reform initiatives. They discussed the importance of engaging doctors in change efforts. Key Takeaways Over the past decade, medical practices have rapidly adopted new management structures and systems to provide quality health care at lower costs. Health care organizations have implemented changes in three categories: 1. Clinical and analytical tools. These include electronic medical records, treatment extenders, wellness and patient-adherence initiatives, data and analytical tools, and other digital technologies for care delivery. 2
2. Payment models. Value-based payment models are an area of significant interest. 3. Management tools. These include management-driven cost controls and treatment protocols, as well as metric-based compensation. Physicians have adopted a variety of tools, and in the next two years they expect adoption rates to increase further. While media buzz has focused on technologies like remote patient monitoring and telemedicine, doctors view foundational tools like electronic medical records and standard treatment protocols as most useful for improving care quality. Figure 1: Tools Deployment In the past two years, the pace of change has slowed or plateaued. Bain & Company research suggests that implementations of clinical and analytical tools, payment models, and management tools slowed or plateaued between 2015 and 2017. Figure 2: The Slowing Pace of Change 3
After years of experimentation, physicians have become more cautious about embracing new systems, especially when the administrative burden is significant. Over 60% of physicians believe it will be more difficult to deliver high-quality care in the next two years, citing complex regulations, increasing administrative burdens, and frustrations associated with electronic medical records. Physicians have become increasingly cautious about adopting new structures and systems without a clear clinical and economic proof of concept. Josh Weisbrod Many components of reform, including value-based payment models, don t have strong physician support. Bain & Company research found that although physicians prefer fee-for-service payment models, they are concerned about health care costs. A majority of physicians (73%) prefer a fee-for-service model over alternatives like pay-forperformance, or capitation. Many believe that fee-for-service (FFS) results in better patient care. In addition, they feel FFS provides the best financial reward, since many variables may or may not reflect accurate measures or direct quality of care. At the same time, physicians recognize that feefor-service is the most expensive model. Figure 3: Physicians Realize Fee-For-Service is the Costliest Payment Model Alternative models are perceived to deliver comparable or substandard patient care. Physicians dislike pay-for-performance systems because they are unpaid for many services, and this model creates a physician bias against complicated patients. Patient non-compliance is also a huge issue, since this can reflect poorly on treating physicians in pay-for-performance systems. To change physician perceptions, more compelling information must be provided about the value of alternative payment models. 4
Figure 4: Physician Perceptions about Care Quality and Payment Models Yet, physicians want to manage health care costs, especially if patients bear the burden. Many doctors try to minimize patients out-of-pocket costs through their prescribing decisions. Figure 5: Drug Costs Affect Physicians Prescribing Decisions The greatest driver of physicians satisfaction is engagement in decision making. Employee Net Promoter Scores (NPS) measure how likely an individual is to recommend their employer to others. Bain & Company found that Net Promoter Scores for physicians who are engaged in organizational decision making is 47%, while scores are -61% for physicians who are not engaged in decision making. Research found that physician-led organizations have a built-in advantage in achieving physician alignment. Physician-led organizations had Net Promoter Scores of 36%. Management-led organizations scores were 11%. 5
Engaging physicians in organizational decision making becomes an equalizer for NPS across management-led and physician-led organizations. Figure 6: Involvement in Decisions Boosts NPS Scores Health care organizations on the forefront of change are empowering physicians. Progressive health care organizations are empowering physicians by recognizing the critical role they play in cost management and are gaining their buy-in to support the move to a value-based model. Clinical and economic evidence are essential for generating buy-in. An example is how this shift is underway in Medtech procurement: 10 years ago. At that time, surgeons were the only decision makers. Products were chosen based on clinical value and experience. Limited, if any, attention was given to economic value. 5 years ago. A shift began as procurement professionals sought to guide purchasing. Products were chosen on the basis of financial and pricing data. This led to frequent conflict with surgeons. Today and beyond. Now a middle ground has been reached. Surgeons and procurement professionals share authority over decisions. Surgeons have become more sophisticated and multidimensional. They are willing to weigh clinical and financial data as well as multiparty interests as part of purchasing decisions. Today, around 85% of surgeons believe that procurement has a neutral or positive impact on cost and quality. Figure 7: Surgeon Perceptions about Procurement Professionals 6
When health care organizations empower doctors, it is easier to implement new management structures to deliver quality health care at affordable costs. Bain & Company s research suggests that many physicians are pushing for evidence that change is worth the required effort and will improve clinical outcomes. Doctors are eager to assume a more hands-on role in identifying a health care model that will help them balance costs and patient care. Bringing physicians back into the decision-making process will help organizations create solutions that physicians believe are worth the required change effort. These solutions will also generate greater momentum for change. To transform the health care industry, we must co-opt the people who have frontline contact with patients. The key is to work with physicians, rather than imposing requirements on them. Tim van Biesen Tim van Biesen is a partner in Bain & Company s New York office. He is a leader in Bain s Healthcare practice. Tim has more than 10 years of management consulting experience in the healthcare sector, advising industry leaders on their biggest opportunities and challenges. Tim s areas of expertise span the full range of healthcare sub-sectors, including manufacturers, payers, providers, and services. In addition to his work with corporate clients, Tim coordinates the firm s advisory work for private equity investors in the healthcare sector. Tim has published more than 30 papers in peer-reviewed journals including Nature, Proceedings of the National Academy of Science, and The Journal of Biological Chemistry. He is an inventor on two patents covering four human genes and has presented his research at International Symposia. Prior to joining Bain in 2004, Tim acquired more than 10 years of experience as a research scientist. Tim received his MBA from the Kellogg Graduate School of Management, Northwestern University and has a PhD and BSc in molecular microbiology from the University of Alberta. He conducted his post-doctoral fellowship at Duke University and the Howard Hughes Medical Institute in the laboratory of Dr. Robert J. Lefkowitz, a world leader in receptor biology and signal transduction research. Joshua Weisbrod is a partner in Bain & Company s New York office. He is a member of Bain s global Healthcare and Private Equity practices. Joshua has more than 10 years of management consulting experience, working with senior executives and management teams to address their most pressing strategic issues. Joshua focuses his corporate work in the payer, provider and healthcare information technology (HCIT)/services spaces. He has advised clients on a range of issues and also led more than 50 due diligence projects for financial and corporate sponsors. In addition to his work with clients, he has held a number of leadership roles in the areas of staffing and recruiting for Bain s New York office. Prior to joining Bain in 2001, Joshua was a Financial Services Analyst for the Board of Governors of the Federal Reserve System in Washington, DC. He holds an MBA from Harvard Business School and a BA magna cum laude with honors in Business Economics from Brown University. 7
Gardiner Morse is a senior editor at Harvard Business Review where he focuses on marketing, innovation, and technology. He has developed articles on a wide range of topics including marketing technologies, data privacy, health care management, and smart products strategy. Before coming to HBR, Morse served for 15 years in a range of editorial and business roles with the publishers of the New England Journal of Medicine. There he developed and launched numerous publications for physicians and the general public, and served as executive editor of Hippocrates, a journal for primary care physicians. The information contained in this summary reflects BullsEye Resources, Inc. s subjective condensed summarization of the applicable conference session. There may be material errors, omissions, or inaccuracies in the reporting of the substance of the session. In no way does BullsEye Resources or Harvard Business Review assume any responsibility for any information provided or any decisions made based upon the information provided in this document. 8