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SAN ANTONIO
MEDICINE
at the time of prescribing, this would limit the transactional burden
of patients not filling prescriptions due to cost, which is known to
Reducing Physician be a significant barrier to medication adherence.
Improvements like these not only decrease administrative burden,
Burnout: The Role but improve patient care and experience.

Health Plans Can Play Value-based Care: Practicing at Top of License

With the emphasis of addressing social determinants of health
By P. Nelson Le, MD, MBA and providing holistic care, many physician practices are struggling
to sustain clinical programs and support staff to provide compre-
Physician burnout is not a new phenomenon, but the recogni- hensive services. As a result, physicians often need to be the care
tion of its prevalence and impact has elevated this topic to national coordinator, social worker, pharmacist, health coach and other roles
attention. in addition to being the medical doctor.
Recent data shows that 44% of physicians demonstrate at least 1 In a fee-for-service environment, these additional responsibilities
symptom of burnout and have the highest suicide rate of all profes- are not reimbursed, require time, and can create tension since they
1,2
sions: one physician dies from suicide each day. Physician burnout limit the number of patients that physicians can care for in a day.
does not affect only physicians; patients are also suffering and there However, in value-based arrangements, incentives are better aligned
is a huge cost to the healthcare system. Physicians who report signs between payors and physicians since physicians are paid for quality
of burnout are twice as likely to have made a medical error. 3 of care rather than volume of patients. This allows physicians to
The root causes of physician burnout are multifactorial. Two focus on providing high-quality care to their patients rather than
leading causes of burnout are due to the increasing administrative filling time slots.
burden and the inability for physicians to practice at top of license. In addition to rewarding quality care and outcomes, payors are
These factors have led to disengagement from the mission that incentivized to offer additional resources and services to help physi-
brought these hard-working, highly-capable individuals to this pro- cians in value-based arrangements care for their patients. One key
fession: caring for patients. to succeeding at value-based care is the implementation of multi-
With this complex issue, all stakeholders in the healthcare ecosys- disciplinary care teams to provide support for patients outside of
tem have a role to play in what needs to be a multipronged solution. office visits. This team approach can help coordinate care and pro-
Here is how payors can play their part. vide resources to patients for transportation, medication manage-
ment, in-home assessments, and chronic disease monitoring, for
Administrative Burden and Complexity example. By extending the reach of the practice, payors can provide
In a survey of 20,000 physicians, the AMA found that 70% spend visibility into the patient’s home environment. As a result, physicians
at least 10 hours per week on administrative tasks with 32% spend- can practice at the top of their license.
ing 20 or more hours per week. 4
Studies show insurance-related transactions are one of the top Restoring the Joy of Medicine
three tasks that physicians wished were more efficient. The back- By creating simplified experiences for physicians and patients, re-
5
and-forth between physicians, patients, and payors to identify the ducing friction in the delivery of care, and supporting physicians
most clinically-appropriate and cost-effective therapy is a significant on their journey to value-based care, payors can have an impact on
contributor to the administrative burden. administrative burden and enabling physicians to practice at the top
Recently, the Journal of the American Medical Association pub- of license. Ultimately, this results in positive health outcomes for
lished a study by researchers from Humana and the University of physicians, patients, and the healthcare ecosystem overall.
Pittsburgh which found that administrative complexity (billing and
coding costs, physician and insurance administrative burden) ac- P. Nelson Le, MD, MBA, Medical Director, Office of the Chief Medical
counted for $265.6 billion of the annual wasteful health care spend Officer, Humana
in the United States. 6
One way forward-leaning health plans can alleviate administrative CITATIONS
burden is to simplify the prior authorization process by digitizing the 1 Mayo Clin Proc. 2019;94(9):1681-1694.
workflow or bundling services under one approval. This decreases the 2 Physicians Experience Highest Suicide Rate of Any Profession
time to complete these forms and ensures that patients have timely – Medscape – May 07, 2018.
access to appropriate care. A second solution is to offer real-time ben- 3 CMAJ. 2018 Oct 9; 190(40): E1216-E1217.
efit checking to providers at the point-of-care. This is especially rele- 4 Medscape Physician Compensation Report 2018.
vant when trying to prescribe medications that patients can afford. 5 Deloitte 2018 Survey of US Physicians.
If physicians had visibility into out-of-pocket costs for patients 6 JAMA. 2019;322(15):1501-1509.
34 San Antonio Medicine • July 2020