Survey Reveals Progress Tracking as Top Challenge
The survey, which gathered responses from 446 clinicians across mental health and primary care specialties, identified patient progress tracking as the single largest barrier to successfully implementing outcome-based payment models. Remarkably, 36% of surveyed clinicians cited progress tracking as their primary challenge—more than double the 15.5% who identified insurance issues as their main concern.
This shift in priorities represents a fundamental change in the healthcare landscape. While insurance complications have traditionally dominated clinician concerns, the emergence of value-based care has introduced new layers of administrative complexity that many providers are ill-equipped to handle. The data suggests that as payment models evolve to reward outcomes rather than volume, the tools and systems supporting clinicians have failed to keep pace with these demands.
Clinicians Drowning in Administrative Tasks
“Clinicians are spending countless hours on administrative tasks when they should be tracking the impact of their delivery and care on patients,” explained Gal Steinberg, founder and CEO of Twofold Health, in a news release obtained by The American Journal of Managed Care® (AJMC®). “The fact that they are drowning in paperwork and don’t have the tools or time to measure how their clients and patients are progressing is alarming.”
Steinberg emphasized the urgent need for industry-wide collaboration: “Our industry needs to join forces to better equip practitioners with the tools and resources to evaluate and document the care they provide.” This call to action reflects growing recognition that individual practices cannot solve systemic infrastructure problems alone.
Medium-Sized Practices Face Acute Strain
The survey revealed that progress tracking, client acquisition, and insurance issues collectively accounted for 72% of all clinician-reported challenges across various practice types and sizes. However, medium-sized practices—defined as those with 10 to 49 clinicians—experienced the burden most intensely.
Nearly half of respondents from medium-sized practices identified progress tracking as their primary operational barrier. These practices also struggled with secondary concerns including client payment collection and the persistent problem of late cancellations or patient no-shows. This data suggests that medium-sized practices lack both the administrative resources of large health systems and the flexibility of solo practitioners, placing them in a particularly vulnerable position.
The administrative weight extends beyond broad outcome measures. Clinicians reported that routine tasks—such as assigning patient “homework” between sessions and monitoring compliance—create substantial additional workload. For providers in mental health and primary care, many of whom operate as solo practitioners, the accumulation of these small but required tasks profoundly affects both workload management and job satisfaction.
The Growing Documentation Burden
“The administrative burden has become so overwhelming that it’s actually preventing us from doing the core clinical work we’re trained for,” stated Vanessa Valles, a social worker and group practice owner at A New Start Counseling. “Progress tracking and documentation requirements take time away from direct patient care and therapeutic presence. When clinicians have tools that reduce that administrative load, we see improvements in staff retention and reduced burnout.”
Valles’ observations align with broader research findings. A nationally representative analysis published in AJMC examined 2019 and 2021 data from office-based physicians and found that those participating in accountable care organizations (ACOs) reported significantly higher documentation burdens than peers in other value-based payment models.
Value-Based Care Programs Increase Workload
The research revealed that participation in any value-based program was associated with a 10.5% greater probability of spending more than an hour per day on after-hours documentation compared to non-participants. However, ACO participation emerged as the primary driver of this increased burden, corresponding to approximately 18 additional minutes per day spent on paperwork.
Beyond time concerns, ACO participants also reported greater difficulty with documentation tasks and a higher likelihood of deeming their documentation time inappropriate or excessive. These findings illustrate a clear pattern: as value-based care programs expand their requirements and complexity, clinicians experience increasing strain—often without receiving adequate tools or support to manage the enhanced workload effectively.
Technology Solutions Needed for Independent Providers
Twofold Health emphasized that the survey data highlights an urgent need for greater investment in documentation support technologies, particularly for clinicians operating outside large health systems. The overwhelming representation of solo practitioners in the survey sample—comprising 61% of respondents—further underscores the scalability challenges that independent providers face when navigating evolving payment requirements and regulatory demands.
As the healthcare industry continues its transformation toward value-based care models, addressing the administrative burden on clinicians must become a priority. Without adequate technological support and streamlined documentation systems, the promise of improved patient outcomes through value-based care risks being undermined by clinician burnout, reduced practice sustainability, and ultimately, diminished quality of care.
