What Does VBC Look Like on the Ground? 8 Key Components

I’m sometimes inspired by a podcast episode to write about a topic. This was the case this week. I’m a big fan of “Relentless Health Value” with Stacey Richter, and this last one was in my top 10 most favorite. Why? Because it had multiple nuggets where Stacey and her guest made VBC concepts so relatable to healthcare professionals that you could easily picture how and why it’s both inevitable and the best thing for patients, providers, and payers.

Here’s the episode 👇️ 

Not all providers love the concepts around VBC. VBC considers primary care an investment, not a cost. It makes complete sense for primary care to fully adopt advanced primary care and to take accountability for their populations. As Stacey’s guest Kenny Cole said (and I LOVE that he said this—thank you!!)”

It’s much easier to understand why it’s not as appealing for specialists, especially surgeons. They can add volume of Relative Value Units (RVUs) with more interventions/procedures, and the weight of their RVUs is high.

Or why hospitals, who depend on filling beds, aren’t as engageable in reducing the use of the hospital.

What I hope changes? Getting on board the non-physician providers offering primary care services, like physical and occupational therapists and behavioral health providers. They have everything to gain, as do patients who need their services, by embracing advanced primary care and directly collaborating on these teams.

More on that, and more from this podcast episode, in the article.

First, I’m making good on my promise in this Linked In post, where I simplify the value-based care “brand,” for lack of a better word. Let’s look at least some of what I consider necessary for fully-adopted VBC practice.

And please check out this week’s sponsor! 👇️ 

Back to Basics—Defining “Value-Based Care”

What I am really defining is VBC in the advanced primary care space, but the principles are interconnected and overlap with other VBC, like condition-specific episode, acute episodes of are, etc.

It’s so easy to throw around a term, isn’t it? I don’t know about you, but I need something tangible to wrap my head around a concept.

Here’s some of what I think of when I think about the hallmarks of VBC (a.k.a. patient-first care), along with fictional patient examples for each. Hope this makes VBC more approachable and you are excited for its inevitable full adoption in American healthcare.

1. Prioritizing Access to Care

This means ensuring patients can connect with the right care, at the right time, in the most appropriate setting – whether that's via telehealth, extended office hours, or seamless referrals. VBC models often support these expanded access points because preventing an ER visit or managing a condition proactively is more valuable than reacting to a crisis. It means structuring your practice or team's availability to meet patients where they are, reducing barriers like transportation or work schedules that often impede timely care under traditional models.

But it also means having the right providers available on site to evaluate and treat and/or triage the vast majority of reasons patients present at the practice for unplanned office visits. Because the reality is that physicians, nurse practitioners, and physician assistants are not necessarily the best or only provider type that a patient should see when they present to a primary care team office visit.

At a minimum, and in my opinion, a primary care practice that’s fully transformed care and receives value-based reimbursement should have a physical therapist (and ideally, also an occupational therapist) and a behavioral health provider (think LCSW, LPC, etc).

Reasoning for PT: They have “direct access to patients” in all 50 states, meaning a physician’s prescription is not necessary. They can evaluate and simultaneously triage and/or treat patients. They can determine if a physician’s evaluation is also medically indicated.

Countless times when I was treating full-time, I would get prescriptions like “Evaluate and Treat. Dx: low back pain,” for example. The PCP didn’t know what the actual diagnosis was. The diagnosis was a symptom. These patients should see PT first. Countless referred patients never even make it through the multitude of barriers to get a PT eval and to avoid unnecessary utilization of care.

PTs are doctorally-prepared healthcare professionals who are MSK and movement experts. We are heavily underutilized at the population level, to everyone’s detriment.

Reasoning for Behavioral Health (which is becoming a more common addition in advanced primary care teams): Primary care providers often have patients present with depression, anxiety, substance use disorder, and other mental health complaints. Why have a barrier of a referral to get help?

The PCP can facilitate acceptance of the behavioral health provider intervention when directly onsite. This is essential for many patients to accept support. The behavioral health provider can collaborate with the PCP in helping decide if a patient should be managed with or without medications. And they have the Collaborative Care Model option to collaborate with a psychiatrist via telehealth, for example, if a higher level of diagnostic support and medical treatment is necessary. These scratch the surface of reasons.

Patient Impact Examples: 

Maria, an hourly worker with diabetes, previously struggled to get daytime appointments. Her provider group now offers evening virtual visits with a nurse practitioner for routine check-ins and blood sugar management, allowing her to manage her condition effectively without losing wages, and ultimately preventing costly complications.

Joe, a patient with a new complaint of low back pain, presents to the practice. While first triaging for red flags, the physical therapist is the first provider to see the patient, identify a mechanical dysfunction likely from a disc derangement, and identify evidence-based treatments that reduce the patient’s pain. The PT teaches the patient how to do this at home, works on postural awareness and short-term positional recommendations to reduce the likelihood of exacerbating the pain, worsening the injury, and therefore allows healing to begin.

The PT will call the patient at a specific time the next day to check on them. They schedule a second appointment for the following day, but instruct the patient to call the 24-hour number should symptoms worsen or they have a question. The PT answers questions the next day via a call, then sees the patient the next day. A total of 6 visits over 4 weeks with asynchronous communication yield resolved symptoms and progression of healing. They schedule a follow-up call for 4 weeks away but know they can reach the PT as needed.

By seeing the patient first, the PT helped avoid imaging, oral medications, injections, an orthopedic visit, progression/worsening of the injury, emergency room visits…isn’t it just so obvious that PTs should be part of primary care teams? Gosh, I hope the needle moves on this soon!

2. Improved Health Outcomes

This is the ultimate goal most of us strive for – seeing patients actually get healthier. In VBC, "improved health outcomes" becomes a central, measurable objective tied to success, shifting the focus from merely performing services to achieving results like better A1c control, lower hospital readmission rates, and improved functional status. It means your efforts in patient education, evidence-based treatment, and follow-up are directly recognized and valued by the system because they demonstrably improve patient health.

Patient Impact Example: John is recovering from heart surgery. His care team helped him secure a high-quality (data-driven) surgeon first. They also know he has some well-managed anxiety and wanted to get ahead of anything that could exacerbate it. The team ensured close communication between him, his wife, the surgeon, and the care teams to prevent avoidable coordination challenges.

The team ensured a seamless transition home, coordinated cardiac rehab, medication reconciliation by a pharmacist, and regular nurse check-ins. He can reach someone on the team at any time, leaving little chance something “urgent” but not “emergent” leads to an ER visit. He has had a smooth recovery and completed his full cardiac rehabilitation program, which we know leads to better long-term outcomes.

3. Trusted Provider/Patient Relationships

VBC explicitly values and ultimately rewards the time and effort needed to build trust. VBC models often allow for more flexible and longer, more connected interactions, team-based support, and consistent communication channels that help forge strong, trusting relationships between the full team and the patient. This hallmark recognizes that a patient who trusts their provider (and the team) is more likely to adhere to treatment plans, share sensitive information, and engage proactively in their health. Genuine trust is needed for a patient to consider their care team “trusted advisors.”

Patient Impact Example: Sarah felt rushed and unheard during brief FFS visits for her chronic pain with her prior PCP. Her new VBC primary care team includes a dedicated health coach who spends time understanding her goals and concerns. Feeling genuinely listened to and supported, Sarah is now more engaged in her treatment plan and reports better pain control and quality of life.

4. Care Transformation

This hallmark speaks to fundamentally changing how care is delivered, moving beyond the traditional office visit model. For professionals, it means embracing new workflows, technologies (like remote monitoring and shared EMRs), and team roles designed around efficiency and patient needs. It means redesigning processes – from patient intake and triage to chronic care management protocols – to be more proactive, coordinated, and patient-centered, rather than simply layering VBC metrics onto outdated FFS structures. It also means full team buy-in, starting with the leadership team.

Patient Impact Example: David, recently diagnosed with COPD, used to only see his doctor when symptoms flared up. Facilitated by redesigned care pathways, he now has a remote patient monitoring device, regular check-ins via telehealth, and proactive adjustments to his action plan, significantly reducing his hospitalizations for exacerbations. Combined with improved comprehensive access to the practice, he hasn’t had a significant exacerbation or an ER visit in over a year.

5. Provider Accountability & Risk-Sharing

This means clinicians and healthcare organizations accept responsibility for the quality and cost-effectiveness of the care they provide. While "risk" can sound daunting and intimidating, it signifies that providers have a stake in the outcome, aligning their goals with the patient's well-being and the efficient use of resources.

It encourages careful consideration of tests, referrals, and treatments based on value (effectiveness vs. cost) and incentivizes preventing costly complications or unnecessary interventions. Providers who make the leap often say they would never go back to fee-for-service. They are much more fulfilled, see patients improving, and often have higher reimbursement levels, including prospective payment arrangements with some payers.

Patient Impact Example: Under a VBC model where her orthopedic group shares risk for joint replacement outcomes, Mrs. Henderson received extensive pre-operative education, optimized physical therapy beforehand, and meticulous post-op coordination, leading to a successful surgery, discharge home to the care of a PT who sees her at home to avoid the friction of transportation, and has no costly readmissions or complications. What motivated the practice to add resources? Exiting pure FFS. The practice was directly accountable for her entire episode of care.

6. Data-Driven Decisions & Measurement

For clinicians, this means using data not just for billing, but as a vital tool for improving care. VBC relies on tracking specific metrics related to clinical quality (e.g., vaccination rates, screenings), patient experience, and cost. This data helps identify care gaps within your patient population, highlights areas for workflow improvement, demonstrates the effectiveness of interventions, and allows for transparent reporting on performance.

Patient Impact Example: By analyzing practice data, Dr. Lee’s team noticed low screening rates for colorectal cancer in a specific patient demographic. Using this data, they implemented a targeted outreach program with mailed FIT kits and navigator follow-up, significantly increasing screening rates and catching several early-stage cancers for patients who might otherwise have been missed until later, harder-to treat, and higher risk of mortality stages.

7. Population Health Management

This shifts the perspective from solely treating patients who present for appointments to proactively managing the health of an entire defined group (e.g., all patients with diabetes in the practice, all members of a specific health plan). It involves using data to stratify patients by risk, implementing preventative measures across the population, and designing outreach programs to engage patients who may not seek care regularly, aiming to improve the group's overall health status.

Patient Impact Example: Robert, who rarely visited the doctor despite having hypertension risk factors, received a call from a care coordinator at his clinic as part of their population health outreach. They discussed his risks, scheduled a screening, and enrolled him in a home blood pressure monitoring program, helping him manage his newly diagnosed hypertension before it caused serious problems and downstream, high-risk complications like kidney disease and stroke.

8. Enhanced Care Coordination

Fragmentation and siloed care is common. It’s not best practice. It’s directly the result of FFS. Care coordination means actively collaborating and communicating with other providers involved in a patient's care – specialists, hospitals, home health, pharmacies, behavioral health, physical rehab providers – often facilitated by care coordinators, navigators, and/or shared technology platforms. The goals include seamless transitions, avoiding redundant tests, ensuring everyone has relevant information, and providing a cohesive care experience for the patient.

Patient Impact Example: Following a hospital stay for pneumonia, Mrs. Davis experienced enhanced care coordination. Her primary care office received discharge information promptly, a pharmacist reconciled her new medications, and a home health nurse visited within 48 hours, all coordinated via shared alerts. This prevented medication errors and ensured she had the support needed to recover safely at home.

Trust as Treatment: The Investment that Transforms Healthcare and Patient Outcomes

Wise words and takeaways from the Relentless Health Value Podcast, Episode 473

Fee-for-service and related market dynamics have chipped away at the trusted relationships between providers and patients. Yet there is a solution already available to address this. Enter value-based care.

Truth: Primary care is a critical investment opportunity. It’s about creating bandwidth to build, strengthen, and deepen the trusted relationships between advanced primary care teams and the patients for whom the teams are accountable.

But it truly takes the incentives to shift for this to come to fruition.

Stacey Richter’s guest, Dr. Kenny Cole of Ochsner Health, said this (from the transcript):

Make more 💵 by seeing more patients or doing more procedures?

Then you will get more volumes of those because that’s what’s billable.

That’s what we get in fee-for-service.

Does following evidence-based practice get rewarded? No.

Do improved patient outcomes get rewarded? No

Do payers and plan sponsors get more return on investment for their members for those higher dollars? No.

Summary of Some Key Points Made in the Episode:

Outcome Accountability:

Clinical teams must be accountable for the outcomes they generate. This is a direct contrast to Fee-for-Service (FFS), which primarily rewards the volume of services. This is the core principle of VBC – payment and success are tied to patient health results, not just the number of visits or procedures.

Team-Based Approach and Shared Responsibility:

Dr. Cole's work involved designing "multidisciplinary team-based models." Snippets mention that in VBC, a physician must "recast themselves as part of a team." VBC thrives on coordinated, team-based care where different professionals work together (nurses, social workers, pharmacists, physicians, etc.) to manage a patient's health comprehensively.

Proactive Management and Reducing Unwarranted Variation:

Dr. Cole provides an example about optimizing metformin use to avoid GI side effects and prevent disease progression exemplifies proactive chronic disease management and tackling "clinically unwarranted practice pattern variations.” A key VBC strategy is to standardize care around evidence-based best practices, manage chronic conditions proactively to prevent costly complications, and reduce variations that don't improve outcomes.

Aligning How Care is Delivered with How it's Paid For:

They discuss the need to "reinvent the business model such that the best-practice clinical pathways and care flows are aligned with financial viability." It implicitly critiques the FFS system where doing the 'right' thing clinically might be financially penalized (e.g., spending extra time on patient education, coordinating care with a specialist). VBC models of care aim to give providers the flexibility to deliver care in the most effective way (e.g., telehealth, team visits, longer consultations) without being constrained by volumes of FFS billing codes for every action.

Moving Beyond Rushed Encounters:

By focusing on outcomes and population health over encounter volume, VBC models can allow clinicians to spend time where it's most impactful, fostering the trust.

Good primary care should be viewed as an investment in health and wellness, not simply a cost center. Failing to invest in robust primary care leads to higher downstream costs, particularly excessive ER spending, avoidable specialty care and advanced imaging, etc.

Embrace these steps for VBC success, whether you are at Step 0 or Step 10 in your journey

Prioritize Trust Building: Actively invest time and effort into building genuine, trusted relationships with patients. This isn't a "soft" skill but a core component of effective, high-value care.

Focus on Patient Education & Shared Understanding: As illustrated by the metformin example, take the time to educate patients, set expectations, and troubleshoot barriers to adherence. Understanding the patient's context and collaborating iteratively improves outcomes.

Embrace Team-Based Care & Accountability: Recognize that high-value care is a team sport. Foster a culture where the entire team feels accountable for measurable patient outcomes and collaborates effectively.

Standardize for Excellence AND Connection: Develop and implement clear care flows for common conditions to ensure clinical best practices are followed efficiently, but ensure these processes also facilitate rather than hinder patient connection and relationship building.

See Beyond Fee-for-Service: Understand the limitations and perverse incentives of pure FFS models. Advocate for and adapt to models that reward value, outcomes, and the proactive management of patient health, even if navigating both FFS and value-based contracts concurrently ("one foot in each canoe") presents challenges.

Believe in and Communicate Goals: Ensure that clinical goals are not only set but are believed to be achievable by the care team and communicated effectively to inspire action and measure progress.

Physician re-casting as team members

Dr. Cole says that physicians should:

• Focus on earning patients' trust and going on a journey with them, rather than expecting patients to simply comply with instructions

• Take accountability for co-producing outcomes with patients and actively work to uncover barriers and challenges when treatments aren't working

• Frame health goals in terms of what matters most to patients (like being able to fish) rather than just clinical metrics

• Build trust and rapport as an essential part of the doctor-patient relationship, which enables patients to trust both the doctor and the science

So instead of saying "take this medication because I said so," successful physicians build relationships where they help patients achieve what matters most to them personally - whether that's continuing to fish, play with grandchildren, or pursue other life passions.

This is really about tapping into someone’s intrinsic motivation and about respect for our patients. This approach recognizes that earning trust and understanding individual drivers leads to better health outcomes than simply dictating treatment plans.

Palliative care providers will frequently talk about “what matters to you” vs. “what’s the matter with you.” But this shouldn’t just be reserved for patients with serious, life-limiting illnesses.

Here’s a quick video and patient example from the Institute for Healthcare Improvement’s (IHI) YouTube channel:

Want another episode recommendation? 👇️ 

(the answer might surprise you…)