Cover: Barriers Primary Care Clinic Leaders Face to Improving Value in a Consumer Choice Health Plan Design

Barriers Primary Care Clinic Leaders Face to Improving Value in a Consumer Choice Health Plan Design

Published in: Health Affairs Scholar, Volume 1, Issue 6, qxad065 (December 2023). DOI: 10.1093/haschl/qxad065

Posted on rand.org Feb 28, 2024

by Tim McDonald, Arindam Debbarma, Christopher M. Whaley, Rachel O. Reid, Bryan Dowd

Primary care clinics are a frequent focus of policy initiatives to improve the value of health care; yet, it is unclear whether they have the ability or incentive to take on the additional tasks that these initiatives ask of them. This paper reports on a qualitative study assessing barriers that clinic leaders face to reducing cost within a tiered cost-sharing commercial health insurance benefit design that gives both consumers and clinics a strong incentive to reduce cost. We conducted semi-structured interviews of clinical and operational leaders at a diverse set of 12 Minnesota primary care clinics and identified 6 barriers: insufficient information on drivers of cost; clinics controlling a portion of spending; patient preference for higher cost specialists; administrative challenges; limited resources; and misalignment of incentives. We discuss approaches to reducing these barriers and opportunities to implement them.

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