Community health centers already have high turnover rates, but the implementation of value-based health care is making the situation worse—with an increasing number of people ready to head out the door.
According to a Modern Healthcare report, many community health centers are finding the transition to a value-based health care model traumatic. More employees are suffering burnout, and professional satisfaction is declining at even higher rates under the implementation of value-based health care.
While those health centers offer primary care to approximately 24.3 million low-income individuals, according to the report, they already have high rates of employee turnover and dissatisfaction, thanks to the stress that comes with caring for complex patients on a fee-for-service pay model.
But then came the quest to move to value-based approaches, as well as to achieve medical home recognition. The report cites a study published in Health Affairs that evaluated workplace satisfaction at 296 centers that were part of the CMS' Advanced Primary Care Demonstration, in which the centers were expected to achieve medical home recognition.
The medical home model uses a team of professionals led by primary-care physicians: nurse practitioners, physician assistants, pharmacists, health educators and medical assistants. The team takes on responsibility for providing or facilitating comprehensive, coordinated and accessible care for a panel of patients; to do so, they look not just at the health of the individuals but also of the whole group. Team members also work closely with patients to encourage them to take better care of themselves.
But researchers found that, over a one-year period during which clinicians and support staff at community health centers worked to achieve medical home recognition, professional satisfaction fell by 10 percent; in addition, the percentage of staff feeling burned out increased by 8 percent. In addition, the number of staff members saying they planned to leave also rose.
"Things got worse across the board over a short period of time, which is concerning," Mark Friedberg, an author of the study and a senior natural scientist at the RAND Corp. says in the report.
Researchers found a decline in overall satisfaction from 84.2 percent to 74.4 percent, as well as an increase in burnout rates from 23 percent to 31.5 percent. Not only did the number of respondents saying they were likely to leave within two years increase from 29.3 percent to 38.2 percent, but the proportion of respondents who said the practice atmosphere was hectic or chaotic rose from 31.6 percent to 40.1 percent.
A recent New York Times report indicated that there could be other issues with value-based care, in that although patients are paying less for their medications and are more prone to follow up in taking those meds, the overall cost of care hasn't declined, but merely shifted. And a separate report from Ernst & Young identifies obstacles to performance and growth for smaller hospitals and health care systems in the value-based care model.
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