Impact of a Primary Care Value-Based Compensation Model.

Abstract

Primary care is essential for achieving high quality population health; however, its future remains uncertain with pervasive provider burnout, compensation structures based on service volume, and systemic undervaluation relative to specialty care. Value-based payment models aim to improve health outcomes and reduce costs, yet their implementation in academic medical centers remains complex. This study examined primary care physicians' perceived impacts of changing to a value-based compensation model in a large academic medical center. A mixed methods study was conducted using semi-structured interviews with 17 primary care physicians across 12 practices affiliated with Brigham and Women's Hospital (BWH), an academic medical center in Boston, Massachusetts. Interview transcripts were analyzed using a hybrid deductive-inductive thematic approach. Quantitative data included changes in panel size, panel growth, the proportion of physicians meeting panel targets, and quality metrics for patients with chronic disease. Three years after implementing a value-based compensation model, the total number of covered lives in BWH's primary care department increased by 31,000, representing a growth rate of 6.8%-9% annually. Physicians identified three primary domains differentiating fee-for-service (FFS) and value-based compensation models: provider experience, access to care, and system-level factors. Reported advantages of the new model included recognition of inter-visit work and reduced productivity pressures. However, concerns emerged about limitations in patient access and persistent systemic challenges, including understaffing. A value-based compensation model in academic primary care may enhance panel management and physician experience. However, long-term success depends on addressing systemic barriers and aligning clinical productivity expectations with value-based goals.