Source: The Chartis Group, 2022
21% of PCPs report having one or both of partial- or full-risk capitation agreements in their practice.
48% of PCPs acknowledge having another value-based agreement, such as participating in ACOs, clinically integrated networks (CINs), shared savings, or bundled payment agreements.
The remaining 31% of PCPs reported not participating in any of these agreements or were unaware of the agreements they had altogether.
Our assumption for this analysis is that physicians who are unaware of their value-based contracts are not positioned to manage to any specific value-based contracting outcome.
Source: The Chartis Group, 2022
| COHORT | AVERAGE PCP TENURE | AVERAGE (MEDIAN) PANEL SIZE | AVERAGE MEDICARE % |
|---|---|---|---|
| Leaders | 19 years | 1,700 (1,500) | 37% |
| Experimenters | 15 years | 1,500 (1,200) | 32% |
| Abstainers | 16 years | 1,000 (800) | 32% |
The majority (57%) of PCPs agree there is an organizational focus on financial costs for their panel, a core tenet of value-based care. What’s more, PCPs broadly believe that this focus will grow over the next 5 years. The forward momentum of this trend persists across cohorts, with all believing today’s focus exceeds the focus 5 years ago and that the focus will continue to increase over the next 5 years.
Unsurprisingly, value-alignment today influences the perceived level of focus and focus trajectory. 65% of Leaders agree there is a focus on financial costs today, and 78% of them agree it will continue to increase, as compared to 50% and 61% of Abstainers for current and future state, respectively.
Source: The Chartis Group, 2022
| COMPENSATION TYPE (% OF COHORT) | LEADERS (N=65) |
EXPERIMENTERS (N=146) |
ABSTAINERS (N=96) |
AVERAGE (N=307) |
|---|---|---|---|---|
| A fixed salary | 46% | 55% | 68% | 57% |
| Based on productivity | 48% | 48% | 28% | 42% | Performance -based bonus (panel, practice or other metrics) | 63% | 44% | 21% | 41% |
| Profit sharing of the business | 25% | 10% | 11% | 14% |
| Other mechanism | 2% | 3% | 3% | 3% |
Source: The Chartis Group, 2022
Source: The Chartis Group, 2022
Source: The Chartis Group, 2022
Source: The Chartis Group, 2022
Source: The Chartis Group, 2022
Source: The Chartis Group, 2022
While PCPs in all 3 cohorts uniformly believe they collect all known diagnoses and use the most appropriate codes possible, the differences in their activities around risk adjustment reflect likely differences in their true performance against this important metric. Leaders are more likely to: see their patients annually (+8pp vs. Abstainers), have established methodologies for documentation (+12pp), actively monitor coding performance (+15pp), and leverage support tools for risk identification and stratification (+17pp).
We just explored the many resources practices employ to improve PCPs’ ability to manage value-based care. We hypothesize that greater infrastructure present at value-aligned practices should translate to a reduced workload and improved job satisfaction.
Broadly, PCPs spend just shy of half of their 49-hour work week in direct patient care and approximately one-third of their time charting. The remaining time is related to practice management and other activities, such as rounding.
Leaders spend less time seeing patients and more time on practice management and other tasks than Experimenters and Abstainers. Said differently, as value-based care alignment rises, so does a PCP’s focus on managing administrative tasks related to the practice. Also, notably, Leaders work on average 3 fewer hours per week than Abstainers. This is consistent with a common narrative around how value-aligned physicians are able to work fewer hours under their risk contracts as they are not incentivized to see patients and instead are incentivized to manage to outcomes. However, it is counterintuitive, given our earlier findings that these same PCPs have larger panels and see more patients per day.
We hypothesize that this dichotomy could be explained by Experimenters being in an unfortunate middle ground, where they have made a commitment to managing value-based care contracts but have not invested in the required infrastructure that will improve their experience doing so. This commitment and lack of enabling infrastructure could create a compounding effect on their workload and reduce their job satisfaction.
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