Transitioning from Fee-For-Service to Value-Based-Care: Equipping Medical Students For the Future

From the 2023 HVPA National Conference

Nathan Yee BA (UMass Chan Medical School), Jack Hanna BBA, David Fish MD, Carolyn Langer MD, JD, MPH

Health economics is a growing area within medical education.1 Given the trend away from fee-for-service (FFS) towards value-based payment systems in the U.S.2, it is important for medical students to understand the basic concepts of the reimbursement models that they will be operating within throughout their future careers.

To gain an understanding of medical student attitudes and competency regarding healthcare payment models, and to develop a curriculum that equips them with foundational knowledge on the subject.

A day of in-person didactics was designed for third-year medical school students as a supplement to their clinical clerkships. The first half of the day consisted of a lecture series covering the theory and evidence surrounding FFS and value-based payment models, as well as the pros and cons of each. For the second half of the day, students broke out into faculty-led small groups in which students roleplayed various stakeholders in a fictitious medical group. The medical group was set to undergo a transition from a FFS-based reimbursement to a capitation-based payment system, and the students were tasked with allocating $1 million dollars from their affiliated health system to accommodate this change. A pre-survey and post-survey were administered that gathered student attitudes and included a competency assessment.

128 students responded to the pre-survey, and 130 students responded to the post-survey. Unpaired t-test was used to analyze this portion of the data. Students reported a statistically significant increase in their understanding of current payment models in U.S. healthcare (p<0.0001). A majority of students somewhat or strongly agreed that providers should understand how they are reimbursed (97.7%), that healthcare finance should be covered in medical school curriculums (96.1%), and that providers have the ability to influence healthcare payment systems (72.7%). There was no statistically significant change in these three attitude questions after the session.

123 students responded to the competency portion of the pre-survey, 124 students responded to the competency portion of the post-survey. A chi-square test was used to analyze this portion of the data. There was a statistically significant increase in the proportion of correct answers from pre (73.7%) to post (84.1%). (p = 0.0005)

A day of lectures and interactive small groups had a significant impact on third-year medical students’ perceived and demonstrated knowledge of payment models in U.S. healthcare. Students overwhelmingly expressed that reimbursement and healthcare finance are important topics to understand as future ordering and prescribing physicians. Given the evolution and variety of payment models, a basic understanding of the advantages and disadvantages of each can help students advocate for change at their respective institutions. This study had limitations as it was generated as a standalone session at a single institution. The post-survey was administered immediately after the session, so long-term retention of the material was not assessed.

Clinical Implications:
Including content on healthcare payment models in medical school curriculums helps students understand how value is quantified in financial terms. As future providers, this understanding is crucial for them to provide high-value care, advocate for patients, and optimize resource utilization.

What are academic medical centers across the country doing to improve healthcare value?

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