Strategies for Physicians Pivoting to Value-based Care

Transitioning to value-based care (VBC) models may be daunting in the short term, but medical practices can expect to reap an abundance of long-term benefits for patients, staff, and their community. As VBC takes center stage as the future of healthcare, it is America’s physicians who are key to its successful adoption.

As a physician leader, it is understandable that you are concerned about your practice’s readiness to make the shift. Leading efforts to set up a VBC model and pay arrangements is no small task. As payers drive VBC, providers are being thrust into the role of implementers, the Advisory Board notes.

If you are new to VBC and just starting this journey, here are six “whys” for embracing the shift:

1. The opportunity to improve clinical outcomes. According to Terry Health’s survey “2023 Perspectives on Value-Based Care,” fully three-quarters of respondents—mostly from healthcare organizations currently engaged in VBC—report a belief in patient-centric care and four-fifths report improving clinical outcomes were considerations for participation. Most respondents thought that they had been at least somewhat successful in improving clinical outcomes, controlling costs, and improving the patient experience.
2. VBC models continue to grow. McKinsey & Company reports expecting the proportion of the insured population in “at risk” contracts to continue to rise significantly: 10 percent annually from 2021 to 2025 as compared with the 1 percent growth of the overall insured population over the same period. The shift to value-based care can be seen across various care model segments and payer types.
3. Primary care is the backbone of medicine. Primary care is struggling. Value-based payments can help ease the burdens onprimary care practices and engage physicians in quality improvement efforts. Since family physicians deliver most of the primary care in the U.S., they represent the greatest opportunity for meeting the goals of improved care quality while reducing costs.
4. It’s a better way to work. The AMA writes the value-based care approach promotes better coordination among healthcare professionals. You are encouraged to work more collaboratively within care teams, where your leadership knowledge, skills and expertise fosters a physician-led, team-based approach.
5. Patients are happier. VBC’s holistic health approach, which focuses on treating the individual’s entire well-being and not just symptoms, can lead to better care experiences and outcomes, building trust and understanding between patients and providers. Patients treated under VBC programs report higher scores on the Healthcare Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.
6. Practices get a revenue boost. A variety of payment models that help to reduce unnecessary hospitalization, including capitation technology, reduced spending, partnerships, and prevention and wellness, can help medical practices achieve financial stability.

Of course, physician engagement demands more than a shift from a traditional fee-for-service mindset. Here are tips to help you fundamentally transform the practice of medicine:

• Join an accountable care organization (ACO). ACOs work with healthcare professionals to enhance care coordination, expand greater healthcare access, and create networks for doctors who come together voluntarily to provide coordinated high-quality care to the Medicare patients they serve. Medicare ACOs now provide care for nearly half of Americans covered by traditional Medicare, a 3% increase since 2023, according to the Centers for Medicare & Medicaid Services (CMS). Today, about 13.7 million people with traditional Medicare are aligned to an ACO. CMS has set a strategic goal of having 100% of traditional Medicare beneficiaries and the vast majority of Medicaid beneficiaries in accountable care relationships by 2030.
• Advocate investment in advanced tools. Artificial intelligence, machine learning, electronic health records, live patient data, predictive and prescriptive analytics, integrated platforms, and other technologies are at the forefront of VBC transformation. Not only do these tools enhance your practice’s care delivery, they also give you and your staff the capabilities you need to design a VBC framework that mitigates risk, realigns incentives, and facilitates better and more cost-effective care.
• Use financial incentives to hold your team accountable. Value-based care ties the amount providers earn for their services to the results they deliver for their patients, such as quality, equity, and cost of care. Through financial incentives and other methods, value-based care programs aim to hold providers more accountable for improving patient outcomes while also giving them greater flexibility to deliver the right care at the right time.
• Standardize processes. According to the Cleveland Clinic, the goal of value-based care is to standardize healthcare processes through best practices, similar to other industries. Mining data and evidence can determine which processes work and which don’t. This forms a foundational “care pathway” to help gain the best results for patients.
• Foster open communication. Create a work culture where your colleagues and staff feel comfortable sharing ideas and concerns. Promote interdisciplinary collaboration by talking with doctors in your network about the coordination of care across practices and appointments. In value-based care, doctors and other providers work together to manage a person’s overall health, while considering an individual’s personal health goals.
• Educate yourself about everything VBC. Continuously learn about value-based care strategies and progress. Browse the latest medical journal articles, take continuing medical education courses, or consult your fellow physicians in your ACO network, for example. Provide education and share your VBC learnings with peers and staff to help them stay updated on developments and align with shared goals.

Taking the time to invest in yourself and implementing the right actions can pay significant dividends as you strive to make your practice successful in a VBC model. If you’re interested in learning more, Innovista Health is ready to help.