Physicians want to learn about value-based care, but few are sure it will pay off: 69% say they want to learn more, while only 33% are confident it will improve their practice's sustainability over five years. That comes from athenahealth's fifth annual Physician Sentiment Survey, which asked 1,045 primary care physicians and specialists. Only 36% say they are comfortable with shared financial risk.
Practice managers who plan contracts, staffing and reporting can use these numbers to judge how much appetite sits behind a value-based care proposal. The survey was fielded online by The Harris Poll in October 2025, and Medical Economics published the results on March 30, 2026.
How financially secure do physicians feel?
The same survey shows the financial mood that surrounds the value-based care question. Of the 1,045 physicians, 67% believe their practice is on solid financial footing. Yet 52% are concerned about their organization's long-term financial health, and 75% worry at least once a year about whether running their practice is financially feasible.
Physicians named three main financial concerns. Lower Medicare and Medicaid reimbursement led at 56%. Staff retention and recruitment costs followed at 47%, and labor shortages came next at 46%.
Small practices feel the pressure most. The survey found that 88% of small practices fear difficulty staying independent. Among all respondents, 49% said they worry more about claim denials than about declining reimbursement rates. That share was 66% for physicians in small group practices and 36% for physicians in enterprise organizations.
Interest in value-based care is high, confidence is lower
The athenahealth data separates curiosity from conviction. The table below lists each value-based care measure from the survey, with the share of the 1,045 physicians who agreed.
| Value-based care measure | Share of physicians |
|---|---|
| Want to learn more about value-based care | 69% |
| See possible financial benefits | 55% |
| Comfortable with shared risk | 36% |
| Confident it will improve sustainability over five years | 33% |
Source: athenahealth Physician Sentiment Survey, 1,045 physicians, fielded October 2025, as reported by Medical Economics on March 30, 2026.
The gap between the first and last rows is 36 percentage points. Roughly one in three physicians expects lasting benefit, while more than two in three want more information. Interest runs well ahead of belief that the model will stabilize a practice's finances.
Shared risk is the sticking point. Only 36% accept it, so a contract that moves downside risk to the practice meets a smaller audience than a contract that only adds quality bonuses. Age shapes comfort with risk. Millennial physicians were more comfortable with shared risk than baby boomers, at 39% versus 28%, a gap of 11 percentage points.
What stops practices from joining
athenahealth asked physicians to name the main barrier to value-based care. Administrative burden and reporting requirements came first at 43%. Uncertain revenue was second at 31%, and patient engagement challenges came third at 29%.
The reporting barrier ties to a wider documentation concern. In the same survey, 46% of physicians named minimizing excessive documentation requirements as a policy priority for lawmakers. That figure was 49% in 2024.
Technology comfort also differs by practice size. About 43% of physicians in small group practices said they are comfortable using AI, compared with 65% in enterprise organizations. A reporting-heavy payment model asks more of a practice's systems, so a 22-point gap in tool comfort matters for the practices that have the fewest staff to build reports by hand.
Data exchange adds friction. In the survey, 73% of physicians said they struggle to exchange patient data across different EHR platforms, and 80% said gaps in cross-system data sharing increase their stress. Another 63% said they feel overwhelmed by the volume of data in patient charts.
How much revenue already comes from alternative payment models?
Most practices already hold some contract that pays outside straight fee-for-service. American Medical Association survey data for 2012 to 2022, summarized by Texas Medicine in January 2024, put fee-for-service at about 70% of practice revenue on average and alternative payment models at about 30%. Those averages have held steady since 2014.
The AMA data shows how widespread participation is. In 2022, 64.3% of respondents reported any revenue from alternative payment models, down from 66.8% in 2020 and up from 57.6% in 2012. Another 86.4% of respondents still received some fee-for-service revenue.
Medicare ACO participation followed a similar path. The AMA found 38.1% of respondents in a Medicare ACO in 2022, against 36.7% in 2020 and 29% in 2014. Texas Medicine reported that multispecialty practices, practices with primary care physicians and hospital-owned practices were more likely to take part in ACOs and alternative payment models than solo practices and independent practices.
What a practice manager can measure before signing
Four numbers from a practice's own records show whether a value-based contract fits. Each one maps to a barrier the survey identified.
- Share of revenue by payment type, compared with the AMA average of about 70% fee-for-service and 30% alternative payment models.
- Hours per month the front office and billing staff spend on payer reporting, which is the 43% barrier.
- Month-to-month revenue variation by payer, which is the 31% uncertain-revenue barrier.
- Denial volume by payer, since 49% of physicians say denials worry them more than rates.
Practices that cannot pull these four figures from their billing and EHR reports start a contract without a baseline. The survey found that 55% of physicians see possible financial benefits in value-based care, and only 33% expect those benefits to last five years.
Sources
- Medical Economics, Affordable care overtakes paperwork as physicians' top concern, athenahealth survey finds, March 30, 2026
- Texas Medicine, Survey: APM Participation Grows, But Fee-For-Service Still Dominates, January 16, 2024
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