In healthcare, building a culture of “going the extra mile for patients” can help overcome a lack of targeted incentives. Many healthcare professionals are passionate about making the right choice for patients, but even they need assistance shifting care from reactive to preventive. Value-based models are more sophisticated than ever with dozens of metrics informing physicians how to deliver the highest value care. This overwhelming list makes it hard to focus on the most impactful indicators, requiring a team effort to achieve targets.

Health systems typically focus value-based compensation on rewarding clinicians, which can lead to a disconnect with clinic staff. These team member contributions are often overlooked, or they are asked to improve performance without added compensation. Like physicians, clinic staff also experience burnout from required documentation, EHR data logging, and responsibility for increasingly larger panels without the same rewards.

Changing How We Think About Incentives

Research indicates that efforts to improve performance on population health metrics are more effective when the entire team is engaged, including non-clinical staff. 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. The study suggests that educating and incentivizing clinic staff has greater results: 

    1.  Small dollar amounts can be relatively significant for these personnel
    2. Incremental near-term steps are easy for them to contribute to
    3. Understanding the relationship between a task and the end goal provides a sense of inclusion and engagement

We discussed the results of the AFM research with Dr. Stacie Vilendrer, MD MBA MS, Medical Director & Family Physician at Stanford University School of Medicine who conducted the study.

“Walk into any primary care clinic, and you quickly realize that medical assistants are an integral and indispensable part of the care team — they increasingly screen, counsel and even coach patients to take action to improve their health. And yet, financial incentives designed to close population-wide care gaps often solely target physicians and other primary care providers.” – Dr. Vilendrer 

“In this study, we conducted focus groups across three health systems to explore how medical assistants felt about financial incentives tied to population health metrics, including which ones they felt they had the power to influence,” said Dr. Vilendrer. “Medical assistants were enthusiastic about the possibility of financial incentives and felt they could influence metrics completed on the same day as a clinic visit, such as screening for tobacco.”

MAs in today’s primary care practices are asked to support value-based goals, with little training or additional compensation. Several barriers to successful adoption of larger population health roles by clinic staff were noted in the studies, including the following.

    • Insufficient understanding of the population health concepts
    • Lack of time for added responsibilities
    • Additional workload without additional compensation
    • Reluctance of clinicians to delegate tasks
    • Uncertainty in making new workflow changes routine

Engaging Clinic Staff Lowers Barriers to Value-Based Care

Both study teams relied on data from staff interviews and results at several health system practices that were driving value-based strategies. One study examined practices from the West coast and the other from the East coast, yet both revealed several key findings related to improved MA engagement and effectiveness within a population health role:

    • Educating MAs about how their responsibilities fit within broader population health goals, including formal training and ongoing open communication with providers, is critical to engaging the staff member.
    • Providing MAs with autonomy and control over incremental achievable goals or same-day-measures (e.g., vaccinations), particularly using detailed protocols, is more desirable than measuring them on multiday measures or other longitudinal metrics. 
    • MAs would welcome direct financial incentives, those in the study having had little experience with them, and compensation totaling as little as ~3% of their average annual base pay would be influential in improving performance.

The conclusions from both studies emphasized the need to be aware of the barriers to achieving the value-based goals and the effectiveness of a team approach. Incorporating the full staff in these efforts should allow providers to practice at the top of their license and generate improvement in performance metrics as a team. Further, additional studies, including one from the American Journal of Accountable Care support a team approach as a means to improving patient satisfaction, another key metric for providers.

Consequently, these studies found that providing staff with small incentives and clarity on how those incentives support value-based care principles would be very effective. Physician leadership is no doubt critical to achieving value-based goals, but the day-to-day activities require staff support. The benefits of these incentives are felt throughout the entire practice, improving the work satisfaction of all members of the clinic team. Ultimately, incentivizing the staff could set off a positive feedback loop of engagement and improvement that lifts the entire team performance.