Changing Health Care Payment Structures

Value-based payment methods effective only if entire care team is trained

By KATIE CAVENDER | HMS Center for Primary Care Research

3 min read

Photo of a physician's hands typing on a keyboard; stethoscope on desk
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Value-based care is a health care payment structure that shifts the focus away from the traditional fee-for-service model that compensates clinicians based on the number of their patient visits. With the VBC model, physicians are paid based on the total number of patients in their roster, also commonly referred to as a patient panel.

The advantage behind this model, proponents say, is that it allows physicians to dedicate more time to those who need it most, including vulnerable patient groups and people who live with chronic conditions. With the VBC model, appointment times for these patients could be as long as an hour without affecting the physician’s pay.

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The VBC model has been discussed among health care leaders for years, and many health systems have begun implementing changes toward a VBC payment structure as a viable step toward health equity and solving issues of physician burnout.

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But implementation in the financial sector isn’t enough. Experts say entire teams, including clinical and administrative staff, need to be trained on how to implement the structure, as a transition to VBC affects many areas of the health care system, from information technology to the reception desk and patient scheduling.

Implementing VBC payment

“Many teams feel like implementing value-based care payment is crossing the finish line,” said Kirsten Meisinger, HMS instructor in medicine at Cambridge Health Alliance and clinical lead for leadership and system transformation in the HMS Center for Primary Care.

“While it’s a huge victory and a step toward health equity, there is still so much work to be done after implementation, particularly with training team members,” she said.

One example is when a patient calls to make an appointment with their long-time physician, but that physician’s schedule is booked for the day. The scheduling team knows this situation well, and will book the patient’s appointment with another clinician in the practice so that the patient can be seen quickly.

Under the traditional fee-for-service payment model, the patient would be booked with anyone available. With VBC, the patient is booked on their original physician’s team so that care gaps can be closed and the relationship between patient and clinician is maintained and strengthened.

If the scheduling team is not trained on VBC, they might suggest that the patient go to an urgent care clinic, which not only costs the organization and the physician money, but means a lost opportunity to close care gaps.

The fee-for-service model trains teams to deliver care in a way that directly aligns with how they are paid, while the team-based approach of VBC extends far beyond payment.

When changes of this magnitude come to any organization there can be bumps along the way. Teams must learn new VBC terms, update processes, and adopt a new way of approaching care.

Writing the playbook

Through her work at CHA, which implemented VBC more than 10 years ago, and discussions with her peers, Meisinger said she realized that there isn’t a playbook for executives and managers when it comes to this work.

“Multiple processes have to change simultaneously,” she said. “There’s been little attention given to guiding health care leaders on the best specific practices for implementing VBC.”

The HMS Center for Primary Care has created an interprofessional, one-day virtual CME course to provide an in-depth introduction to VBC for managers, executives, and health care colleagues.

Course faculty will define common terms in VBC and associated concepts. Participants will gain innovation and transformation strategies to improve both patient care and experience in the transition to VBC.

This live virtual course takes place on April 21, 2023, 8 a.m. to 3:50 p.m. ET. Learn more and register here.