Follow the money: Barriers to entry for independent physicians

Accountable care sounds like a great concept, but physicians have a number of reasons for being slow to join. Accountable for Health CEO Mara McDermott, JD, discusses those reasons — and notes that value-based care is not going away in the U.S. health care system.

Medical Economics: In 2024 there was a Commonwealth Fund study that examined why many primary care physicians do not participate in value-based care. Can you discuss some of the barriers to entry for those practices, getting involved with value-based care and accountable care?

Mara McDermott, JD: I think that the most common things that we hear are instability. So there are models, it can be, I think, at times, unclear, what's going to happen with those models in the future. It is a huge investment. We've done a lot of work around the investments to make the leap into these models, health, IT and staffing and myriad other payment systems, revenue cycle, like all these things have to change to get into these models. It is a big investment to make for a small organization if you think that model may only be around for three or four years. I think the administration has done a lot to try to address that problem by introducing LEAD as a 10-year model, by introducing ACCESS as a 10-year model, they are trying to give more time to create some stability there. The other thing, I think, is thematic for this administration, that where we hear feedback all the time, and I am, like, totally aligned, is around complexity. So the models, I think, by virtue of government programs, you've seen this sort of layering of administrative requirements, refinements to benchmarks, refinements to risk adjustment. But every time there's a refinement, there's a new set of rules that are incredibly complicated, especially if you haven't been following the ACO journey for 12-plus years. I think we see this administration taking really seriously the idea of burden reduction and trying to simplify, fewer quality measures, more transparent approaches to the financial methodology, and more tools for small and rural practices in particular to receive some funds upfront to make those investments and to support their journey as they move through these programs. And then the last thing I would say is, I think that for a while, what we heard from clinicians is like, they could kind of ignore value-based care, because it would go away, right? There's so many things that are trendy, and was this just another trend? And maybe it would go away. I would say now, 12-plus years into the accountable care organization movement, same for kidney, same for oncology, we've been at this for a long time. It should be pretty clear that it's not going away, and that the best path forward is to find a way to participate, whether that's through a convener or directly participating in a model. But those are some of the critiques that we've heard in the past.