Six Ways to Help Physicians Win at Downside Risk

2019-07-15T13:38:28+00:00July 8th, 2019|

Six Ways to Help Physicians Win at Downside Risk

Megan North
President, Value-Based Care

Despite the slow pace of adoption, the shift from fee-for-service to value-based payments remains a matter of when, not if.  Seemingly in a bid to speed up the shift, the Centers for Medicare and Medicaid (CMS) recently proposed five new, optional primary-care payment models aimed at easing physician practices into greater risk.

Now is the perfect time to make the effort to encourage physician practices to transition to risk.

Primary Care First and Direct Contracting both offer physician practices a significant opportunity to assume risk and both models feature fixed payments that will make revenue more predictable and reduce some administrative burdens. Still, 61 percent of physicians believe pay-for-performance models will damage their practices, adding costs to achieve quality measures and creating more administrative burdens, according to a recent survey by the Doctors Company1. Given this entrenched opposition, the onus often falls on the health system to ease physician apprehension about the perceived negative impact of going at risk.

Health systems looking to accelerate the adoption of downside risk among their employed and affiliated physician practices should take advantage of the CMS’ new payment models to start a dialogue, but only with the right collaborative approach.

The best physician collaborations prioritize strategic care management, trusted information, common performance measures, and the right resources.

Here are six ways to engage physicians and help them successfully transition to downside risk:

Resolve misconceptions about downside risk. It’s important to identify and work through any barriers before asking physicians to take on additional risk. Historically, risk contracts were driven by physician practice management companies that were topline valued on Wall Street and focused on aggregating as much at risk revenue as possible to show growth. These companies didn’t invest in the infrastructure and were not a long-term success. Savvy and experienced physician leaders carry the memory of failures past and will likely view any attempts to quickly shift to downside risk with a healthy dose of skepticism. Today, however, there are foundational differences that are helping physicians succeed at downside risk. For one, access to actionable data is revealing trouble spots and helping physicians understand early on whether or not a contract is performing.

Make physician leaders an integral part of governance. Ultimately, nothing is ordered or purchased in healthcare without a physician order. The governance structure should allow for genuine ownership by physician leaders and they should take the lead on driving clinical workflows that support downside risk. There must be transparency between the organization and physician leaders who should have access to thoughtful and precise information about risk stratifying populations, including correct funding and cost allocations related to physician performance under risk. These leaders must be disciplined and constantly looking at high level population data to individual physician performance to set expectations and take action.

Give physicians access to tailored information. One common problem across healthcare organizations is a failure to take the time to deliver consistent, usable information about physician performance. Physicians are driven by facts, thus they must believe the data you share is data worth using if they are to be held accountable for performance. A yearly report card is insufficient. Physicians under downside risk require daily, weekly, and monthly reviews on individual performance as well as benchmarking data. The most critical factor in having credibility with physicians is giving them the ability to drill down to the granular details of specific cases that drove an outcome that was outside of the norm. If you want to be viewed as a trusted source of information, physicians need to see that you are not just broad brushing performance.

Identify problems early on. It’s also important to partner with physicians and quickly expose key issues. Potential problems include specialist rates or an inadequate network that is driving patients to receive care in less optimal environments such as the ER. There must be a line of sight back to physician leaders. When you give physicians precise information on what is happening now, what has happened before, and what needs to happen next, you will have strong and willing partners who drive better outcomes.

Ease administrative burdens. I hear a lot about physicians being taxed by administrative burdens. Physicians and their staffs should be treated like customers. You do this by making sure their basic needs are met. Physicians should have timely and accurate pay, smooth authorization processes, and supportive case management. As a result, you can gain their affinity to drive better healthcare outcomes.

Communicate about value. Physicians are more likely to respond to consistent discussions on how to practice from a value perspective (cost, quality and access), rather than a top-down punitive approach to improving performance under downside risk. The corrective action process should include support and education to help physicians understand underlying variations within their control. You must show them the data and strategies that will help them remove barriers to success.

Another common challenge organizations must solve is helping physicians balance the differences between disease management and downside risk. While it is important to meet long-term disease management goals, going at risk also requires physician practices to have a laser focus on delivering effective healthcare right now. This is essential as most payer contracts are only 1-2 years.

The best physician collaborations prioritize strategic care management, trusted information, common performance measures, and the right resources.

The bottom line: Now is the perfect time to make the effort to encourage physician practices to transition to risk. Use the new CMS primary-care payment models as the catalyst knowing physicians must have the people, systems, data, and technology to provide the right treatments, move patients through care settings efficiently, perform clean handoffs, ensure physician orders are followed, and understand any barriers to physician orders.


  1. The Doctors Company “2018 The Future of Healthcare: A National Survey of Physicians”
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