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Dr Mark Friedberg: How Practices Shifting to Value-Based Care Models Can Alleviate Burnout


When shifting to the value-based care model, organizations should do a few things at a time instead of trying to do too much as once, said Dr Mark Friedberg, MD, MPP, Senior Natural Scientist, Director, Boston Office, RAND Corporation.


How can practices shifting to value-based care models try to mitigate the effects of the requirements to alleviate some burnout?

This is the thing everyone wants to know. Payment reform is coming. How can we respond to it in a way that doesn’t deteriorate the work environment for our staff and hopefully that improves things for everybody: patients, staff, and the practices bottom line. So, I would say a couple of things. First, it is important not to try and bite off too much at one time. Try to have a plan for doing a couple of steps with certain payment models, and do that for a couple of years, let them gel, and then go on to the next thing. I think if you try to do bundle payment here, and ACO there, and medical home over here, that can be a recipe for too much going on all at once. The other key things that other systems have done a good job with is to try to wrangle all the different performance measures that are coming from all these different systems into something that makes sense to individuals within the practice. We have a pluralistic payment system, where there’s lots of different payers for any healthcare organization. If you’re dealing with let’s say a dozen different major payers and including, but not limited to, the government payers, and each one of them is coming in with what could easily be dozens of measures, you could, as an organization, be handling about 250 to even more than that different performance measures across all these payment programs. Passing those down directly to your frontline staff is going to be very difficult on them. It’s very hard for an individual human to respond to that many different incentives at once. So, one thing you can do at the top at the organization is say, “Look, we’re going to take all these measures down to a very small set of high priority measures for us this year, and we going to give clinicians and practice managers this small set that we’re just going to focus on, and let them work on those for a while, and maybe even strategically surrender on some measures that just don’t line up with the rest.” If you try to get them all, it’s a little bit difficult for the organization to respond in a rational manner.

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