**10. Limitations and obstacles**

The limitations of the value-based health-care model are that it must be led by physicians and that can pose as a problem. If physicians sense that this new model can limit their gains with reimbursement, they may be inclined not to follow through with the necessary steps to make it work.

Physicians are also worried they have little to no time with the IPU team, lack of transparency with the providers, and find it hard to meet quality expectations. Some physicians are not implementing a value-based healthcare because they fear it is too risky with no real assurances.

Other physicians say that this model is beyond the scope of their practices. Should an internist be concerned about organizing someone's efforts to quit smoking? And so, this only adds on to the physicians' responsibilities and with their work load.

Another problem raised is that some fear that tying the physician salaries directly to outcomes might encourage them to refuse to treat the sickest patients who are more likely not to get better.
