In Medicare Advantage value-based care, women PCPs outperform and outearn their male peers

© makyzz - stock.adobe.com

Women primary care physicians (PCPs) participating in full-risk Medicare Advantage (MA) value-based payment models earned more than their male counterparts and delivered better clinical outcomes, according to a new study published May 16 in JAMA Health Forum.

The findings show a reversal of the well-documented gender pay gap in medicine, raising new questions about how different payment structures affect equity and quality in physician compensation.

“In this cohort study, women PCPs in value-based payment models had equal or better-quality outcomes and higher value-based earnings compared to men in their practice groups,” the authors, led by Ishani Ganguli, M.D., M.P.H., of Brigham and Women’s Hospital and Harvard Medical School, wrote in the study.

The study included 872 primary care physicians (520 men and 352 women) working in 15 practice groups across seven states. All participants were engaged in full financial risk-sharing arrangements with MA plans via partnerships with agilon health. Together, they cared for more than 223,000 patients enrolled in MA.

Using 2022 patient-level claims and data from 13 MA payers, researchers compared per-patient physician earnings and clinical outcomes, adjusting for a range of demographic and practice-level factors.

On average, women PCPs managed smaller patient panels and cared for a higher proportion of female patients but had similar specialty backgrounds and degrees as their male peers.

Better outcomes, lower utilization

Patients of women PCPs were more likely to achieve controlled hemoglobin A1c levels, receive eye exams and attain higher scores on a composite Medicare Star quality measure. Those patients also had lower rates of emergency department visits and hospitalizations.

• Hemoglobin A1c control: 94.2% for women PCPs vs. 92.2% for men.
• Eye exam receipt: 81.3% vs. 77.8%.
• Hospitalization rate: 153.9 per 1,000 vs. 182.9 per 1,000.
• Emergency visits: 651.5 per 1,000 vs. 693.1 per 1,000.

A pay gap reversal

When it came to earnings, women PCPs slightly trailed men in traditional fee-for-service payments but outpaced them under value-based arrangements — earning about $275 more per patient annually.

• Value-based earnings:
  • Women PCPs: $2,236.45 per patient/year.
  • Men PCPs: $1,931.78 per patient/year.
• Fee-for-service earnings:
  • Women PCPs: $454.49
  • Men PCPs: $475.86

Researchers attributed the pay reversal largely to fewer hospital visits and emergency care needs among patients of women physicians ­— metrics that are financially rewarded under value-based payment models.

The findings build on a growing body of research suggesting that the way many women physicians work doesn’t match how traditional fee-for-service models pay. Studies have shown that female physicians often spend more time with each patient and handle more care between visits — chart reviews, follow-up messages, coordinating care. But, because fee-for-service systems reward volume over depth, that extra effort often goes unpaid.

Value-based payment, on the other hand, seems to play to those strengths. In models that reward quality, outcomes and cost savings rather than sheer visit numbers, women physicians not only delivered better results — they got paid more for it.

As the authors of the study put it, value-based care may simply be “better aligned to practice patterns more common in women.”

Patient ratings lag behind

Despite outperforming on most clinical issues, women PCPs received lower patient satisfaction scores. After adjustment, women scored 2.7 points lower than their male counterparts on patient-reported ratings collected via validated Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys.

This discrepancy is consistent with prior research showing that women in medicine often face more critical evaluations from patients, despite delivering equal or superior care.

With MA plans now covering more than half of all Medicare beneficiaries, the structure and incentives of MA payment models are increasingly influential in shaping physician compensation and behavior.

The findings suggest that expanding value-based care could help close longstanding gender pay gaps — while rewarding better outcomes and more patient-centered care.

Still, the authors caution that the study was limited to physicians who opted into full-risk arrangements, and payment data reflected practice-level reimbursements, not necessarily individual take-home pay.

“Equal pay could carry benefits beyond fair compensation, including reduced burnout and improved retention of the increasingly female primary care workforce to care for the aging U.S. population,” the authors concluded.