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Becker's: Why Health Systems Need Help with Value-Based Care

Becker's: Why Health Systems Need Help with Value-Based Care

November 3, 2023

November 3, 2023

By Kyle Wailes, Wellvana President & CEO

By Kyle Wailes, Wellvana President & CEO


Wellvana CEO Kyle Wailes writes in Becker's Hospital Review that half measures are holding back hospitals from real progress in value-based care.

This article first appeared in Becker's Hospital Review.

It’s tough to be a health system right now.

I’ve spent enough time in hospital boardrooms this year to confidently report that the headaches are widespread.  

Expenses are growing twice as fast as Medicare payments. It’s as hard as it’s ever been to hire nurses. And the emergency department is being used by the sickest patients as a catch all.  

Value-based care was supposed to solve these problems, but it hasn’t yet.  

At Wellvana, we think half measures are holding back hospitals from real progress. While there’s appetite for value-based care, it’s been too much of a “toe dip” — to borrow a phrase from Rita Numerof. Partial-risk programs don’t truly incentivize hospitals to innovate the way they need to. There are just too many competing interests in many legacy systems. 

According to Numerof & Associates’ annual “State of Population Health,” health system leaders are holding their noses even as they continue to buy up independent practices and bring PCPs into their system.   

  • Only 25 percent of healthcare executives feel prepared for transition to being paid for performance rather than productivity.   

  • Two-thirds of hospital CEOs question how much cost control they have over primary care physicians, where so many care decisions originate.   

  • A mere 10 percent of revenue for hospitals is tied to risk-based contracts.   

But you get what you give.  

Because of halfhearted efforts, the revenue generated by value-based care remains miniscule.   

We get it: The infrastructure just isn’t there. And the risks are too great to truly commit to the work it takes to do value-based care right.   

Full-risk is really the only way to jump in. But there’s a reason health systems fear full-risk.  

It’s really hard work.   

  • Who's going to take on all the upfront risk and seed the efforts that take time to produce savings?  

  • Who will do all the work that the new programs require? Health systems have enough trouble hiring and retaining nurses as is.  

  • Health systems also have invested millions in their current programs and systems. They can’t justify wasting months on implementation and training for new tools. 

This is where choosing a partner becomes priority number one. 

Health systems can make primary care their new front door and worry less about getting “heads in beds.” But they need help to bridge the transition from fee-for-service medicine. 

  • Getting your doctors on the right program tracks takes extensive underwriting. Some might be ready for full-risk value-based care while others need a partial-risk program like MSSP as a steppingstone. 

  • It requires substantial upfront investment, primarily in people. Technology won’t be enough to get doctors to change the way they’ve practiced for decades. They need someone who will inspire and educate them.  

  • Data must take the lead. Your EHR, alone, may not be enough to identify patients who should be your priority. 

So why can’t a health system do this on their own?  

Hospitals have huge budgets, tons of personnel and immense clinical expertise. Value-based care, by comparison, is simple. But it requires a relentless focus on quality over quantity.  

If a dramatic dip in ER utilization scares a hospital, then they might need someone to hold their hand through the shift. 

But their patients will thank them. By doubling down on preventive measures, they will be healthier. And they will be spending less on unnecessary or duplicative care. 

We’re excited to partner with AdventHealth to lead the way and show other health systems how effective value-based care can be at scale.  

The task ahead is immense. But the cost is too great to wait. 

Kyle Wailes is President, Chief Executive Officer and Board Member of Wellvana, a value-based care physician enablement company based in Nashville, TN. Founded in 2018, Wellvana improves outcomes for patients, providers, payors and health systems across 25 states.