Exploring Value-Based Care: Insights from Industry Experts

Over the past 40 years, the Fee-For-Service (FFS) model has dominated healthcare payment, incentivizing providers to maximize revenue by increasing service intensity, contributing to healthcare expenditure skyrocketing to nearly 20% of the U.S. GDP. This growth trajectory, unsustainable at federal, state, and individual levels, has led to the emergence of value-based care (VBC) as a framework to realign incentives, aiming for lower costs and higher quality care.  

At the Nashville Health Care Council’s Crucial Conversations event on May 9, members engaged with a panel of healthcare experts who, drawing from their diverse experiences in building prominent VBC companies, tackled the common skepticisms surrounding VBC discussions. 

Panelists included Christiana Beveridge, President & Chief Medical Officer, Upperline Plus; Ryan Donnelly, Senior Vice President Strategy & Innovation, Premise Health; and Matt McLaughlin, Senior Vice President, Population Health, Oak Street Health. The conversation was moderated by David Mishkin, Senior Vice President, Valtruis.  

The Crucial Conversations series by the Nashville Health Care Council is intended to dig delve deeply into critical topics facing the healthcare industry. Council members hear from expert panelists and keynote speakers on cutting edge healthcare trends and actively participate in small group discussions to address some of the industry’s most pressing issues. By focusing zeroing in on specific healthcare challenges through crucial conversations, Council members are armed with new insights they can take back to their organizations and impact positive change.  

Four Most Common Types of Value-Based Care Models: 

David Mishkin began the conversation by quoting “show me the incentive, I'll show you the outcome.” Stating there is a misalignment in the way we pay for care in the healthcare industry and that the system is deeply influenced by incentives.  

He explained further, that VBC encompasses four predominant models 

1. Quality Linked Bonus Payments 
2. Bundled Payments  
3. Shared Savings 
4. Capitation 

Each model represents a different level of provider accountability and financial risk. 

Three Key Value-Based Care Insights from the Expert Panel: 

1. Develop relationships and address root causes. “We need to practice differently, with easier access to primary and preventive services, and longer patient appointments to develop relationships and address root causes,” said Donnelly. “It's about ‘whole person care,’ addressing not just the physical but also the mental, and social aspects of health. By addressing these issues, we can achieve better outcomes, which ultimately reduce costs.”
2. Never do more than three things. “First, ruthless prioritization is key. Focusing on the core essentials that move the needle is paramount for success. Secondly, personal heroics are inevitable in healthcare. We must all be willing to dive into the details and tackle challenges head-on, no matter our job title. Lastly, there's a danger in succumbing to the belief that certain tasks are beneath us as we climb the corporate ladder. In health care, every task, no matter how small, contributes to the greater mission of improving patient outcomes. It's a lesson in humility and dedication that we must carry forward." 
3. Shift from reactive to proactive care. "Value-based care isn't just a buzzword; it's a transformative approach to healthcare delivery,” said Beveridge. “The Oak Street experience exemplifies how marrying ruthless data focus with streamlined workflows empowers providers to prioritize patient well-being over administrative hurdles. By incentivizing quality and standardizing protocols, we're not just treating symptoms, but transforming outcomes. It's a shift from reactive to proactive care, and it's the future we're building—one where doctors can truly focus on healing.” 

"In value-based care, you're incentivized to prioritize the patient's well-being. With streamlined workflows and data-driven behavior changes, there's hope for its success," said Beveridge.  

Voiced Skepticisms of Value-Based Care: Small Group Report Out 

During small group discussions, Council members highlighted a key challenge: operationalizing value-based care amidst industry turnover. They questioned how to manage the continuum of care and address social determinants for model success. Physician buy-in emerged as crucial; without alignment, sustainable success is unlikely. The consensus leaned towards incremental steps for implementation, emphasizing that value-based care need not be an all-or-nothing endeavor. Clear, focused steps were deemed essential for effective operationalization. 

Evolve Alongside the Healthcare Industry 

As members of the Nashville Health Care Council, you have the opportunity to engage in crucial conversations that will shape the future of healthcare. Staying ahead of trends is vital for your organization's sustainability in this fast-paced industry. Explore hot topics, collaborate with leaders, and discover innovative strategies. Check out our engagement calendar and reserve your spot in upcoming discussions today.