Chronic conditions have rightfully gotten a lot of attention over the past few years. We know the gradual, progressive degradation to a person’s health and well-being that diabetes or heart failure can cause. There are acute issues that can cause serious and rapid setbacks for our patients, though, like a sudden onset of an infectious disease.

Many physicians, providers, and facilities appear to practice medicine from a perspective of isolation. Professional isolation has been named as a contributor to physician burnout and disillusionment, but this goes further. The thought that we are on an island with the patient, solely reliant on what’s in front of us with no contact to the outside world – either where the patient’s been or where they’re going – can cause drastic problems for the patient and those seeking to control medical costs. Redundant care, gaps in services, incorrect clinical judgements, and patient harm all arise from this problem of perspective.

In 2024, The Center for Medicare and Medicaid Services (CMS) implemented a supplemental code, G2211, for primary care providers to add-on to existing Evaluation and Management services. The idea is to give PCPs a financial boost for the ongoing care and relationship with their patients. According to CMS, “G2211 captures the inherent complexity of the visit that’s derived from the longitudinal nature of the practitioner and patient relationship.”

Patient financial responsibility plays a significant role in revenue management. As out-of-pocket expenditure continues to rise, healthcare providers face challenges in collecting payments, leading to increased accounts receivable (A/R) and uncollectible revenue. Understanding the impact of patient responsibility and implementing effective strategies are essential for maintaining financial stability and delivering quality care.

In primary care, the concept of patient engagement has emerged as a key driver of improved patient outcomes. Imagine a scenario where every patient not only leaves the clinic with a treatment plan but also with a clear understanding of their role in their health journey.

As Season 2 of BoPC’s podcast keeps reminding us, relationship is a key component to high value health care. Certainly, frequency of visits aids in building a trusting relationship. But we sometimes forget that helping a patient feel cared for plays an even greater role. Proximity, touch, compassion, and empathy all facilitate this feeling. Sitting at eye level, within a few feet of a person shows them you’re engaged and, in turn, engages them.

The US Centers for Medicare and Medicaid Services, through their Innovation Center (CMMI) announced a new ACO program to go live in 2025 – ACO Primary Care Flex. The hope is to build on the data, experience, and successes they have had with their other models that promote primary care, but with a focus on rural and underserved regions.

J Michael O'Connor, MD (or Mick, for those who’ve met him!) is a Pediatric Emergency physician and VBC advocate and expert. Recently, on his website (cite here), he gave an elegantly simple explanation of some of the alphabet soup associated with value-based care.

I had the honor and pleasure once of sitting in on a broadcasted conversation with Faisel Syed, MD on the Sacred Patient-Physician Relationship. (Faisel and Friends) That discussion got me thinking more about the special rapport needed between the Person we call the Patient and the Healer for healthcare to be effective and to optimally create value.

One of the first and most important challenges an organization faces when moving from strictly fee-for-service (FFS) healthcare delivery to value-based care (VBC) is aligning physician and provider compensation to the new priorities of VBC. If this gets left to be done “later” or not at all, the disconnect between incentives will make VBC success very difficult. 

We have an unfathomable amount of data available to us today in healthcare. Beyond our clinical data, we have multiple discrete fields of other bits and bytes that we can look at to discover better ways to care for our patients. Sometimes, though, in our zeal to find problems or solutions, we get things a bit wrong in putting the data together into useful, actionable insights.

Here’s another article in the medical literature that was needed to verify common sense – an all too frequent occurrence in healthcare, as we seem to often forget it (e.g., handwashing). This one deals with a well-known social risk.

As a follow-up to the VBC Drivers article on Preferred Provider Networks, this article will focus on the importance of at-risk Primary Care Physicians engaging Specialty Physicians in driving Value-Based Care (VBC) outcomes through the development of High Value Networks (HVN) for continued performance improvement in VBC models.

A good proportion of healthcare delivery in the US happens on the fly. Even when an office visit is scheduled in advance, many practices don’t start any work on a patient until they see the whites of their eyes. Mrs. Jones shows up, and we look through the chart to see what needs to be done in the moment. This approach opens the door for inefficiency, ineffectiveness, missed opportunities, poor experience, and low-quality outcomes.

Throughout this series of articles, we’ve discussed value-based care (VBC) drivers of gross income – attribution, risk coding and activities-based bonuses – and spent a good amount of time on drivers of net income, those that lower medical expense. Of these, we have looked at access, Annual Wellness Visits, and managing patient care. These six levers get pulled by most all organizations and practices to some degree regardless of their position on the VBC spectrum.

In this series on the drivers of success in value-based care (VBC), we’ve looked at elements that improve gross revenue and are halfway through the discussion of VBC components that help decrease medical expenses. This installment will tackle the complex topic of “Care Management,” so buckle up and hang on!

This series has been focusing on levers to be pulled that can increase revenue in value-based care (VBC) practices. The second installment started looking at ways to decrease medical expenses, thereby increasing the potential revenue through shared savings or premium risk (Link to Part 2). Part 3 will now dig into the Swiss Army Knife of VBC, the Annual Wellness Visit (AWV).

As more practices and organizations pursue the principles of value-based care (VBC), they look for ways to improve their financial outcomes, the drivers of net revenue. Part 1 of this series focused on some of the main determinants of gross revenue in VBC and how to increase the size of the gross revenue bucket, or pie, depending on how hungry you are. These next installments will speak to the ways of decreasing medical costs, thereby increasing the risked savings to be shared or kept, decreasing the amount of pie eaten by medical expenses, thereby increasing the remainder in the bucket after expenses are paid.

We’ve become very familiar with the revenue drivers in fee-for-service (FFS) healthcare delivery over the past 100 years. Find the highest priced visits, treatments, and procedures a doc can perform and run as many patients as possible through those visits, treatments, and procedures. Since reimbursement rates for medical services have been going down, net revenue increases have more recently been driven by adding new types of visits or procedures to a practice’s repertoire and constantly honing efficiencies in moving people from the front door, through the exam/treatment room, and back into the parking lot as quickly as possible.

The Health Care Payment Learning and Action Network released a measurement of Alternative/Advanced Payment Models (APM) for 2023, showing the types of payments physicians and providers received overall and based on payer type. The measurements show a positive trend toward value-based care (VBC) payments, and the breakdown by payer was even more telling.