The health care industry is facing a crisis, warns the chief medical officer for Inovalon. Risk and quality measurement are major contributors to the administrative burden faced by physicians, which is causing them to leave the practice of medicine. And that means reduced access to care.

Paige Kilian, M.D., chief medical officer, Inovalon, calls herself an internist by training and a primary care physician at heart. It’s why she keeps doctor-patient interactions front in center in her role at Inovalon and the company’s role in the industry.

It’s also why she’s concerned about a looming health care crisis: The more the industry piles on the paperwork that physicians must complete, the more it undermines what they are there to do, which is to provide quality care to patients.

Dr. Kilian, pictured, expressed these concerns during a recent panel discussion at RISE National on how to integrate quality and risk programs. While the industry has come to recognize the need to streamline quality and risk programs, she says stakeholders are failing to realize that the “fabric of our health care system is unraveling in front of us as we place more and more administrative burden on physicians.” These burdens are driving physicians out of practice and ultimately reduces access to care, she says.

She cites a 2016 study published in the Annals of Internal Medicine that found outpatient physicians only spent 27 percent of their day directly engaged in patient care. Nearly 50 percent of their time was spent on administrative matters. And the quality measure demands have only increased in the last six years, adding to provider abrasion, she says.

“The access to care is that physician-patient interaction,” she told RISE in a follow-up interview after the conference. “It’s that doctor-patient in the room, and the whole system is balanced on that interaction…I think of it as a big, inverted pyramid balanced on that interaction. And as we reduce that interaction, we take away the time and patient care…the foundation is shaken. So, I think access to care is really the crux of risk and quality.”

Everything depends on the physician being able to see the patient and that’s being undermined by demands from the industry, including meeting health plans’ need for physician documentation to validate claims, according to Dr. Kilian. It’s a vicious cycle leading to burnout, she says, compounded in the last two years by the pandemic and the loss of staff, inadequate personal protection equipment, and frustrations around vaccinations.

The industry was already facing a doctor shortage prior to the pandemic. Indeed, a 2020 survey by the AAMC projected a shortfall of 139,000 by 2033. The toll of COVID-19 exacerbated these shortages and a January AAMC survey of 20,000 physicians at 124 institutions across the country now finds that one in five doctors plan to leave medicine in the next two years and one in three is looking to reduce their available hours in the next two years.

“You can see this accelerating,” she says, “and we need to get a hold of it. My strongest encouragement to the industry is that we view it as the crisis that it is. Yes, we have to achieve what we have to achieve in outcomes and measurement. But first we have to make sure that the doctor-patient engagement hours are available.

Small successes

There have been small steps in approaches to integrating risk and quality departments that have helped address the issue, she says. Empowered physicians groups have driven some of this integration, insisting that health plans limit their interactions with them by sending a monthly list of all their requests. But not all physician groups have that type of relationship or standing with their health plans.

“I’m also aware of provider engagement teams that have driven the engagement, the integration themselves, so risk and quality remain siloed in the organization, but they're asks of the physician funnel through provider engagement. So, the provider engagement team serves as the integration point,” she says.

These approaches provide a more efficient process of getting information to health plans, but it also addresses the urgency of reducing the administrative burden on doctors. “It’s critical to coordinate this outreach to doctors with clear messages, showing them the value in what they are being asked to do,” she says, citing tasks like prior authorization and quality metrics.

If physicians have the perception that they are being asked to do something that poses no value to their patients or themselves, they won’t buy in to the demands, Dr. Kilian explains. “When health plans provide clear, streamlined message to docs with evidence of the value that’s being achieved, they’ll be far more successful,” she says. “Docs need to see that patient care is being improved by this, outcomes are being improved by this, and also what the financial benefit is to the docs themselves.”

Actions for health plans

Dr. Kilian acknowledges that solving the problem isn’t easy, but she does have suggestions to help health plans begin to address the issue:

  • Recognize the urgency of the problem for health care delivery and the industry as a whole
  • Commit and prioritize the move to integration of risk and quality—if teams are too territorial about their roles and a complete merger isn’t possible, at least consider combining the data output, using the same tool or platform, or combining the messaging
  • Provide clear communication to physicians with the value of the ask

“Plans need to show doctors, this is why we’re doing this, and this is what we’ve achieved. Thank you for your contribution. Here’s what we’ve accomplished so far and here’s where we are headed. I think that kind of messaging will go a long way toward engaging doctors in a process that they are a bit skeptical with at this point,” she says.

Since most health plans don’t do an effective job of communicating these messages, Dr. Kilian says a health plan that shows its value and offers physicians financial incentives will capture their attention. “A physician or practice has very limited time to engage. If you don’t capture their attention, they’re going to prioritize other matters. Give them a reason to prioritize you.”