Today's employers want two thingswhen it comes to their health care benefit programs: valueand quality. To support this quest, leading brokers,employers and employer coalitions continue to push for reform inour health care system, aimed toward quality-based payment overvolume.

A growing body of evidence shows that the nation's 123,000certified physician assistants (PA-Cs) lower costs while improvinghealth care quality. As a result, they can play a crucial role inhelping health care organizations implement value-based reforms.

The road to value-based care is not an easyone

Employers and health care systems are working on thetransformation to a value-based care system at the same timeseveral other health care trends are presenting fresh obstacles. Asthe U.S. population ages, more patients suffer from chronicdiseases and complex medical conditions, spurring a greater needfor specialty care and imposing more demands on our nation'shospitals.

What is more, the American Association of Medical Colleges predicts acontinuing physician shortage. So, the demand for care is goingup while the supply of providers is going down, as the nation worksto fundamentally change the health care deliverysystem.

Help is available

The realities of provider shortages, increasing demand forservices, and system changes are why PAs can make asignificant impact. According to new data from the NationalCommission on Certification of Physician Assistants (NCCPA), thenumber of Certified PAs continues to grow. The number of PAsper 1,000 physicians has increased over 23 percent over the lastthree years alone.

The percentage of PAs working in high-demand and high-needspecialty areas has also grown more than 13 percent over theprevious three years. Some specialties have seen the number of PAsmore than triple in the past decade. So why is this datagood news as we work to create a value-based care system? There arethree key reasons:

PAs are a cost-effective solution to the growing demandfor health care services.

First, PAs are filling a provider workforce shortage at amanageable cost. Many hospitals are already experiencing a dearth ofdoctors. According to NCCPA's Statistical Report of Certified PAs by Specialty, over3,200 PAs now work in hospital medicine, a 21 percent increase overthree years.

PAs often manage patients throughout their hospital stay, with aphysician available to see the patient for the most complexclinical issues. Hiring PAs costs a hospital less than hiringadditional physicians, and is probably less challenging, given thephysician shortage. Data from NCCPA's latest survey reveals theaverage salary for a certified PA working in Hospital Medicine is$108,797, compared to the averagesalary of a Physician Hospitalist of $222,363.

Related: How physician assistants are helping controlhealth care access

Specialty medicine practices are also finding it cost-effectiveto hire well-qualified PAs to meet their patients' needs. Accordingto a report in JAMA Internal Medicine,about 1 in 4 specialty medical practices employs physicianassistants or nurse practitioners today, and nearly half ofmultispecialty practices use them as well. This is goodnews at a time when specialty medicine is in high demand, and costcontinues to rise.

PAs help health care organizations improvequality

Second, in addition to being lower cost providers of care,numerous studies also show PAs provide care at a level that meetsthe quality of care provided by physicians. A recent study comparing two hospitalist groups— one with a high PA-to-physician ratio (the “expanded PA” model)and one with a low PA-to-physician ratio (“conventional”) — hasfound no significant differences in important clinical outcomesachieved by both groups.

A study of PAs in emergency medicine shows improvements in carequality metrics and patient satisfaction scores. This means thathospitals with provider shortages can hire PAs to fill staffingneeds, at a lower cost, without compromising the quality ofcare.

An additional role PAs play is helping hospitals reduce theirreadmission rates, a quality metric often tied to value-basedpayment. For example, one organization in New York has developed aPA home care program, in which PAs make house calls after hospitaldischarge. The most common home intervention has been medicationadjustment, particularly for diuretic agents, hypoglycemicmedications and antibiotics. Upon comparing 30-day readmissionrates for the control and home care groups, the home care grouprate was reduced by 25 percent, according to a study.

Many PAs are leaders of value-based carereforms

As many health care systems transition to value-based care, manyPAs are playing a day-to-day role in implementing new systems andprocesses to handle new payment arrangements that track and reportquality metrics.

As a 2017 article in Revenue Cycle Intelligencepointed out:

“Many hospital leaders and physicians face greater caredelivery, administrative, and patient access demands underalternative payment models. However, the payment models alsorequire hospitals to reduce health care costs while managing morerequirements. In a seemingly impossible balancing act, somehospitals are turning to physician assistants to shoulder some ofthe additional responsibilities.”

Because of their broad education and comprehensive experiencemanaging patients, many PAs are being tapped for new leadershiproles either developing or leading quality improvementinitiatives.

The employer role

Despite their proliferation in numbers and leadership roles,some patients still don't understand the role of the PA as a careprovider. Brokers and other benefits professionals can play anessential role in helping employees understand that they canreceive top quality care in any setting from a certified PA. Articles in employee newsletters can offer guidance on the rigorouscertification maintenance requirements of PAs, who must completesubstantial continuing education credits every two years and passwritten assessments every 10 years. Benefitsprofessionals can also highlight media articles or other sources that show the breadth ofspecialties and clinical settings where PAswork.

Looking ahead

Transitioning to a value-based care system is a high priorityfor employers who care about reducing costs and improving outcomes.However, this transition isn't easy for providers, especially in ahealth care system with a shortage of physicians, a proliferationof administrative and organizational tasks, and a notable growth inan aging and medically complex patient population. Fortunately,certified PAs are stepping up to help, reducing labor costs whilefilling workforce needs, improving care quality, and taking on newroles to strengthen quality initiatives that lead to better healthoutcomes. Employers can play a valuable role in educating theiremployees and health plans about this important trend.

About the Author: Dawn Morton-Rias, Ed.D,PA-C. is President and CEO of the National Commission onCertification of Physician Assistants (NCCPA), the nation's onlycertifying body for PAs. She has been certified as a PA for over 30years and has worked in family medicine, addictive medicine, GYN,acute care for the homeless and education. For moreinformation visit www.nccpa.net.