Clinicians Cite Progress Tracking as Top Barrier in Value-Based Care

As states and federal programs accelerate the shift to value-based care, a new national survey suggests clinicians face a widening gap between policy expectations and the tools available to meet them.¹

Tracking patient progress emerged as the biggest barrier—more than insurance—for mental health and primary care clinicians adapting to outcome-based payment models, according to October 2025 survey findings released by Twofold Health, an artificial intelligence (AI) clinical notetaking platform.

Clinicians Are “Drowning in Paperwork”

Of 446 clinicians, 36% identified progress tracking as their top challenge—more than double the percentage who cited insurance issues (15.5%).

“Clinicians are spending countless hours on administrative tasks when they should be tracking the impact of their delivery and care on patients,” Gal Steinberg, founder and CEO of Twofold Health, said in a news release obtained by The American Journal of Managed Care^® (AJMC^®). “The fact that they are drowning in paperwork and don’t have the tools or time to measure how their clients and patients are progressing is alarming. Our industry needs to join forces to better equip practitioners with the tools and resources to evaluate and document the care they provide.”

Demands Outpace Available Tools

Progress tracking, client acquisition, and insurance issues collectively accounted for 72% of clinician-reported challenges across practice types and sizes, but medium-sized practices with 10 to 49 clinicians felt the strain most acutely. Nearly half of respondents from medium-sized practices said progress tracking was their primary barrier, with client payment collection and late cancellations or no-shows being secondary concerns.

Clinicians reported that both standardized outcome measures and routine tasks, such as assigning or monitoring patient “homework” between sessions, add substantial administrative weight. For providers in mental health and primary care—many of whom operate as solo practitioners—the accumulation of small, required tasks has a profound effect on workload and job satisfaction.²

“The administrative burden has become so overwhelming that it's actually preventing us from doing the core clinical work we're trained for,” Vanessa Valles, social worker and group practice owner at A New Start Counseling, said in the release.¹ “Progress tracking and documentation requirements take time away from direct patient care and therapeutic presence. When clinicians have tools that reduce that administrative load, we see improvements in staff retention and reduced burnout.”

The Documentation Burden of Value-Based Care

Findings published in AJMC echo these concerns.³ In a nationally representative analysis of 2019 and 2021 data, office-based physicians participating in accountable care organizations (ACOs) reported significantly higher documentation burden than peers in other value-based payment models.

Participation in any value-based program was associated with a 10.5% greater probability of spending more than an hour per day on after-hours documentation, compared with no program participation. ACO participation was the primary driver, corresponding to 18 more minutes per day spent on paperwork, greater difficulty documenting, and a higher likelihood of deeming documentation time inappropriate. Together, these data illustrate a pattern where clinicians are increasingly strained as value-based care programs expand their requirements without equipping doctors with the proper tools.

Twofold Health says the data highlight a need for greater investment in documentation support technologies, particularly for clinicians operating outside large health systems.¹ The overwhelming representation of solo practitioners in the sample (61%) further reflects the scalability challenges that independent providers face when navigating evolving payment requirements.

References

1. Tracking patient progress is clinicians' biggest challenge as value-based care mandates expand nationwide. News release. Twofold Health. December 9, 2025. Accessed December 9, 2025.
2. Primary care providers and behavioral health. AJMC. May 20, 2019. Accessed December 9, 2025. https://www.ajmc.com/view/primary-care-providers-and-behavioral-health
3. Apathy NC, Patel V, Rolle TL, Holmgren AJ. Physicians in ACOs report greater documentation burden. Am J Manag Care. 2024;30(Spec No. 6):SP452-SP458. doi:10.37765/ajmc.2024.89552