Aligning Incentives Through Accelerated Provider Adoption of Value-Based Care

In recent years, a growing number of providers and payers in the United States have pursued value-based care (VBC) programs over traditional fee-for-service (FFS) models in hopes to improve patient outcomes while lowering costs.

In this interview with Integrated Healthcare Executive, John Fryer walks through what challenges still exist for providers seeking to implement VBC models, as well as how the accelerated adoption of VBC could impact the industry at large.

What challenges have providers faced when transitioning from FFS to VBC?

Providers have encountered a number of challenges that have slowed the progression of VBC. It starts with the lack of “attractive” VBC contracts that are win-win-win for all stakeholders: the patients, the providers and physicians, and the payers. VBC, as a model, only works when all 3 stakeholders are in a mutually beneficial relationship. If you do not have a value-based contract that aligns those 3 stakeholders, there will be an uphill battle for everybody from the start.

I think data has also challenged providers in the adoption of VBC. To be able to perform in VBC, you must have information on the populations in the payment model and an understanding of each unique patient's individual needs. Over the last decade, I think providers and physicians have succeeded at aggregating clinical information, with the adoption of electronic medical records and digitization. But this is only part of the equation.

To be successful, VBC requires connectivity between the payer, social determinants of health data, and clinical data. That has been a missing piece for most providers as they have entered VBC arrangements. One of the other barriers is health care infrastructure. As we think about organizations that have been successful at adopting VBC, in many cases, these are organizations that have the infrastructure in place to consume information and translate it into insights.

Another big challenge that ties into my first point is the lack of standardization in VBC programs. Under the Centers for Medicare & Medicaid Services, Medicare and state Medicaid programs have their own approaches to VBC. Then, commercial payers have unique VBC models, each with their own quality measures, data standards, and incentive models for providers.

The lack of standardization has brought the industry to a point where it is administratively burdensome for physicians. This has definitely contributed to burnout.

From a provider perspective, what I often hear is health care does not seem to be focused on the patient. Providing care involves a lot of clicking buttons and tracking measures because a specific payer has asked the provider to do so. At the end of the day, that does not change the care the physician is providing to the patient. From a provider perspective, a big frustration is the patient not being centered in the model.

Thank you for that insight, John. How would you say technology and other strategies can be used to alleviate some of those challenges?

Technology and infrastructure are a foundational component to be successful in a VBC model, by driving adoption and creating a long-term sustainable approach. I do not think technology, in and of itself, is the solution. You cannot just implement technology and expect to be successful in VBC. It comes down to having a technology infrastructure that can capture a 360-degree view of an individual patient.

By “360-degree,” I mean to say this includes payer information, clinical information generated at the point of care, and historical clinical information from when that patient ended up at a hospital, an emergency department, a laboratory, etc. What has this individual's complete claims history shown of their experience with the system?

The panacea for connecting the dots is understanding each patient at a much more unique level, and that is where it is important to factor in social determinants of health. Many providers do not have great access to information about social dynamics and, in many cases, have been uncomfortable having that conversation at the point of care. Now, that is changing and SDoH are becoming part of the conversation. But I think technology can accelerate understanding of the individual member.

The model we are focused on with Tribus ensures that, at the end of the day, the physician has all the information they need at the point of care to make a clinical decision. It is about taking all that data that is created from technology and translating it into an actionable insight, because data, in and of itself, is not going to solve the VBC challenge.

How do you think accelerating the adoption of VBC will impact patients, providers, payers, or anyone else in the industry you would like to mention?

The accelerated adoption of value-based models will further align incentives across all stakeholders. That starts with the patient, includes the provider who is responsible for their care, and ultimately involves the payer. It will refocus incentives around truly managing an individual's health vs a transactional or episodic experience a patient may be having.

By and large, the way our system operates today is, we have an acute incident or a patient calls their physician and says, "I feel X, Y, and Z," and then a bunch of activity starts. VBC allows us to align incentives upfront for all those stakeholders to be vested in managing a patient’s health—and that includes the patient. That is an important piece of VBC. You can have the best payer-provider relationship, but if a patient is not engaged in their own care, you will not achieve the results and sustainable model to make VBC successful.

From a financial, business model perspective, accelerated adoption of VBC changes the health care system’s transactional model to one that rewards quality and outcomes vs just productivity.

Is there anything else we have not mentioned yet that you would like to add?

With Tribus, the important thing is to continue giving control back to providers and get them back in the business of caring for patients.

We hear a lot of frustration at the provider level that too much of the work they do is organized around administrative tasks and activities as opposed to practicing what they went to medical school to do: the art of medicine. Tribus focuses on physician-to-physician education and evolution in the value-based model, and we believe this will generate improved outcomes for all 3 stakeholders.

This will enable physician-led, consumer-driven, team-based care, which the health care ecosystem needs to ensure that win-win-win relationship.

About Mr Fryer

John Fryer is the president of Tribus, where he leverages his extensive experience in physician and VBC strategy to oversee operations and growth efforts. He also serves as senior vice president of national markets for Lumeris. John leads a team that develops solutions to support organizations as they transition to VBC, and he is responsible for the development of new partnerships. He has focused his career on driving business model transformation, leading project teams to create executable strategies focused on growth and long-term organizational sustainability.

John holds a bachelor’s degree in economics with a minor in entrepreneurship from Wake Forest University and a master’s degree in health care leadership from Brown University.