Value-based care adoption is a journey, not a destination. And the map you follow can make all the difference

Bartley Bryt, MD: ©Privia Health

What is the transformation and what is the value-based care journey, how is the financial system in health care changing, and how does that change impact health care practice?

The health care system has been steadfastly forging ahead toward a value-based care (VBC) reimbursement model over the past several years. As we enter the seventh year of Medicare’s Quality Payment Program (QPP) and continue to see new alternative payment models (APMs) implemented and tested by both CMS and the private payers, it’s clear we are still in the early phases of this complex journey.

These reimbursement model changes are redefining the role of the physician practice. Public and private health care payers are increasingly trying to transfer the financial risk and administrative burdens to the practice and individual provider, necessitating heightened administrative efforts to document care delivery and outcomes. This evolution has given rise to what we now know as value-based care.

As 2024 progresses, providers across the health care spectrum must adopt strategic measures to tackle the complexities of evolving VBC arrangements and lay the groundwork for enduring success in VBC delivery.

Mark Foulke: ©Privia Health

What are some of the challenges and how is the system changing from a clinical practice perspective?

Physicians today are facing significant challenges on all fronts – from the complexities of transitioning to VBC, an increase in administrative burden on many fronts, the integration of new technologies and analytics capabilities, and ensuring appropriate compensation for the care they deliver to patients.

At the same time, physicians are in search of tools that enable them to maintain autonomy, deliver consistent, high-quality care to any patient across all payers, remain financially viable, and adapt to the ever-changing health care landscape for years to come. Embracing VBC demands more than a simple change in mindset; it requires a fundamental transformation in how physicians practice medicine and care for patients.

Tech-enabled platforms and a robust, physician-centric leadership approach are critical to help transform clinicians and individual practices into efficient, value-based primary care-centric networks. This approach not only enhances clinical care delivery and the patient experience, but also gives physicians the flexibility they need to progress towards a VBC framework.

Physician practices must educate themselves about the evolving system to solve these challenges and realize the quadruple aim

Physician practices must educate themselves about the evolving system to achieve the quadruple aim of reducing the cost of care, improving population health, enhancing the patient experience, and boosting provider satisfaction. Given the complexity of health care today, a strategic approach is essential to navigate the numerous care and payment options available, ensuring both physicians and patients have access to the choices that best suit their needs. Practices, especially those new to VBC contracts or operating with slim margins, should adopt a slow and steady approach in embracing VBC contracts, while accelerating the transformation of their clinical practice.

Embracing this shift demands a plan, vision and a deliberate infusion of spirited innovation, knowledge, experience, resilience, and efficiency into health care delivery and payer contracting. Clinicians must also keep pace with changes in clinical practice, maintain the commitment to keep patients at the heart of every decision, and uphold the sanctity of the doctor-patient relationship.

Further, practices should carefully evaluate how they approach risk–payers offer many options including upside only agreements, downside risk arrangements or specific quality and other measurement-based agreements that must be thoroughly assessed in consideration of the practices capacity to manage their population under the terms that will drive success under the chosen arrangement.

Practices should understand and learn from the past and put the lessons learned to good use

Your practice should avoid taking on more financial risk than it can manage. This means you must expand your knowledge beyond clinical medicine to understand how health care is funded; how health care cost is incurred; how your patient's insurance plan, whether private or public, influences patient behavior and cost; and how much of that cost is in your practice's control.

VBC typically evaluates cost, quality, and satisfaction across larger patient populations than an individual provider's panel. Consider the overall practice patterns of your partners and the specialists to whom you refer, the overall process of care provided by the health care team including front desk staff, office managers, medical assistants, and nurses, among others. When you are growing your practice or joining forces with others whether clinical practice affiliations or expanding your practice business, do your homework, and go at a measured pace.

Many practices are partnering with others to take care of administrative tasks and business operations through loosely affiliated management arrangements. Carefully evaluate these potential business practice partners before committing to relationships that could unduly restrict your freedom. Understand their knowledge, skills, culture, and motivations, and of course their ability to execute. Employ your common sense to choose partners who have physician governance and incentives aligned with the way you want to practice.

You must pick an educated and capable partner to succeed in this world of change

Primary care in the United States is undergoing significant changes – some positive, others less so. As chain retailers enter the primary care market, hospital systems acquire practices, and primary care becomes a central focus of VBC delivery, physicians need dependable partners. These partners should support physicians through the changing facets of practice management and ensure they maintain autonomy over their valued practices.

With a careful, measured approach towards VBC, physicians can confidently face what lies ahead, skillfully navigate the shifting landscape, and most importantly, play a pivotal role in shaping the future of health care in the United States.

Dr. Bartley Bryt is the Chief Medical Officer for Privia Health. Previously, his career path has including roles as Chief Medical Officer at Bright Health Care for IFP/MA and the Neue Health line of business, Chief Clinical Officer Brighton Health Plan Services, Executive Vice President, Chief Operating and Clinical Officer at CareCore National, and leadership positions at UnitedHealthcare/Oxford Health Plans

Mark Foulke is a transformational leader focused on delivering operational excellence to patients and providers. As Privia Health’s Executive Vice President of Transformational Value-Based Care, he leads the effort to transition existing and new provider markets toward additional value-based arrangements. He also oversees clinical and value-based operations and partners with market leadership to optimize performance-based reimbursement programs.