As the industry moves deeper into value-based payment models and takes accountability for the health of populations, primary care is serving as one of the highest priorities for health systems and networks alike. We are at a critical juncture where independent, affiliated and employed physicians, as well as the employers and health systems working with them are seeking ways to allocate limited resources to provide more coordinated, higher-quality care at a lower cost, and position themselves as the provider of choice in their markets. 


At the heart of this is the role that practice staff plays in delivering and succeeding in these value-based care models. Research indicates that efforts to improve performance on population health metrics are more effective when the entire team is engaged, including non-clinical staff. This study shows that a team based care model led to its patients visiting emergency departments less in the first 30 days after discharge. There is no denying that practice staff are the backbone of primary care value-based care. 


Drastic changes in the U.S. healthcare system over the past several decades have affected healthcare professionals’ responsibilities and work experiences. Changes include adoption of electronic health records, shift to value-based care models, and evidence-based practices and transition of many medical practices from physician owned to ownership by an integrated delivery system.  The Covid-19 pandemic has only exacerbated this problem with a Forbes survey showing up to 47% Of U.S. Healthcare Workers Planning to leave their positions by 2025.


Value-based care (VBC) delivery  requires practice staff to adopt a shift in mindset, accountability, and additional roles and responsibilities than what’s currently seen in the traditional fee-for-service (FFS) world. There is a need for very specific technical and administrative capabilities to operate in a practice that is adopting or entrenched in value based arrangements. These include:


Managing payor specific portals / source of gap information with higher focus on quality measurement: According to a 2016 Health Affairs study, medical practices report that their physicians and staff spend more than 785 hours per physician per year dealing with external quality measures – adding time equivalent to care for an additional nine patients per week. This problem is exacerbated by the lack of payor agnostic solutions and payor specific information requirements, making it cumbersome for physicians and staff to deliver care with the administrative burden that it brings.


Patient Experience: CAHPS and HOS ratings (a rating focusing on patient experience) account for more than 32% of overall Centers for Medicare & Medicaid Services (CMS) star quality ratings. An increased focus on this rating is forcing provider groups to ensure that they are spending additional time on patient experience and satisfaction, more so than they would be in the FFS environment.


Engaging patients in preventative care: The value-based model places more emphasis on preventive care, to keep people healthy and prevent hospital admissions and ED visits. In a value-based care model, providers aim to achieve certain quality goals for a given population of patients while reducing unnecessary cost or utilization. The most seamless way to see good outcomes, while avoiding unnecessary cost, is to get strong patient engagement in preventive care. This requires additional coordination and effort from the staff to engage patients on their preventative screenings and measures, ensure adherence and completion, etc. 


Additional practice work streams that are a direct result of the industry’s shift to VBC include additional focus on cost and utilization reduction initiatives like individualized care planning for high risk populations, collecting and submitting supplemental documentation and coordinating chart chases from Payors, aligning on actual attribution and patient panel with the payor, etc.


These major transformations and added responsibilities that come with VBC, intensify job demands and disrupt the work experience, which may negatively influence work–life balance, job control and alignment of professional and personal values. These shifts, and the emotional challenges of change and change fatigue, may contribute to workplace stress and dissatisfaction.


Researchers found that clinicians and support staff at community health centers working to achieve medical home recognition reported over a one-year period that their professional satisfaction declined by 10% and feeling burned out increased by 8%. More staff members also said they would leave. ⁵


Meanwhile, the majority of medical groups are still operating under the fee-for-service environment that leaves them unequipped in terms of staffing optimization, resources, and inefficient workflows. Only 43 percent of physicians feel they have the tools needed to succeed in value-based care. This poll of 1,090 healthcare leaders showed that this lack of resources was considered the top challenge to VBC adoption by 25.3% of respondents, the largest percentage of any single category. This variation often contributes to increased physician and staff frustration and burnout, less efficient, uncoordinated care with unsatisfied patients.


Given the complexities that the value-based care environment brings with it, below are a few strategies to help retain staff and reduce overall practice burnout:

1. Aligning Staff Compensation with Value-Based Care Outcomes

Most health systems and integrated networks typically focus value-based compensation on rewarding clinicians, which can lead to a disconnect with clinic staff. As previously mentioned, practice staff are heavily contributing to value-based care outcomes and it is important to create an incentive design that aligns their effort and input to the revenue generating output. Studies from two different primary care organizations point to unrealized improvements and suggest that organizations think differently about how to incentivize clinic staff. Notably, both the Annals of Family Medicine (AFM) and the Journal of the American Board of Family Medicine (JABFM) published articles that found targeted, smaller incentives for medical assistants (MAs) could have an impact on value-based goals. This additional income can help create overall employee satisfaction and retention for the practice.

Read Stellar Health’s January blog post on incentivizing non-clinicians to value-based care performance.

2. Technology Adoption and Workflow Optimization

Staff suffer when, instead of being able to focus on patient care, they have to put in time and energy to administrative work and charting, which has grown increasingly complex in recent years. With a greater focus on VBC, systems and medical groups need to adopt technology and workflow design that reduces this administrative burden. Currently, staff spend between 26-41% of their time on documentation. Leveraging technology and interoperability can remove the burden of repetitive manual tasks; making staff and documentation more effective while also returning that time to direct care. Efficiencies include using solutions that are payor agnostic, promote staff and clinicians to operate at the top of their license and complete high value tasks, that require minimal double documentation and can integrate within their EMR, etc. 

3. Employee Benefits Design

Another notable effort that can help with staff retention is to offer flexible benefits committed to promoting team members’ physical, emotional, and financial well-being through a host of programs. These include paid time-off (including sick, maternity and paternity leave), an employee assistance program, wellness credit and rewards programs, an online fitness platform, retirement and financial planning, team member discounts, and more. These additional benefits can lead to higher employee satisfaction despite the intense workload.


As elucidated throughout the article, staff retention is a major factor and area of focus for organizations that are looking to succeed in value-based care. By deploying a few of the strategies mentioned above, a more sustainable work environment can be created that promotes better care delivery and patient outcomes while also being mindful of overall physician workload.


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