Navigating the Future of Value-Based Care — Peter W. McCauley, Sr.

Talking Trends
4 min readDec 1, 2023
Peter W. McCauley, Sr. and Reetika Kumar

The pursuit of value-based care (VBC) has become a central focus for providers, payers, and employers alike. As we navigate the intersection of healthcare and business priorities, it’s essential to evaluate the appetite for VBC across key stakeholders, understand the impact of the pandemic, and consider the role of risk in shaping the future. Above all, we need to consider how best to implement VBC in order to achieve health equity.

At the recent Becker’s Payer Issues Roundtable, Independence Health Group’s Reetika Kumar and I took part in a session on “Where Value-based Care is Headed and How to Think Differently About Risk,” moderated by Becker’s Molly Gamble. Our conversation covered many of the issues we are currently facing, along with our predictions for the future of VBC. Here are a few takeaways.

VBC has the potential to improve patient outcomes and streamline care delivery, so all stakeholders are expressing varying levels of interest. Payers are perhaps the keenest, as they acknowledge the long-term benefits of a value-driven approach, which is proving to be cost-effective while improving the overall quality of care. Providers are next, as they recognize the potential to improve patient outcomes and streamline care delivery. Employers, facing the impact of rising healthcare costs on their workforce, are increasingly seeking collaboration for high-quality, cost-effective care.

The COVID-19 pandemic served as a catalyst in accelerating the shift towards VBC. It laid bare the pitfalls of fee-for-service, compelling stakeholders to reassess healthcare delivery. While the financial challenges faced by hospitals in 2022 may temporarily temper risk appetite, this period of reflection could ultimately strengthen the case for VBC, aligning financial sustainability with improved patient outcomes.

Communication on at-risk revenue goals has dwindled, but historical context shows leading systems maintain a willingness to take on more financial risk under the correct circumstances. This underscores the industry’s evolving dynamics and the need for flexibility in goal-setting. Rethinking risk involves challenging assumptions, considering it not merely as a financial metric but also as a catalyst for health equity goals. This calls for acknowledging blind spots in data collection, crucial to identifying and addressing health disparities and reflecting a commitment to equitable care.

Navigating the intersection of risk and health equity reveals potential challenges. Risk, if not approached deliberately, may work against health equity goals. Leaders must be mindful of how risk structures may inadvertently worsen existing health disparities. Investing in cultural competency training for providers and promoting VBC programs that collect data on inequities aligns risk strategies with health equity goals.

Our journey towards value-based care requires an ongoing dialogue. Prioritizing equity, investing in innovation, and redefining risk collectively pave the way for a healthcare system that truly serves all. The evolving dynamics underscore the need for flexibility in goal-setting, reflecting a commitment to adaptability and continuous improvement in the pursuit of a healthier future.

Peter W. McCauley, Sr. has a 30 year track record of profitable, inclusive health care leadership. He is a well-respected, actively practicing pediatrician serving Chicago’s far south side for over 25 years. His expertise in value-based health care, combined with the ability to lead and influence provider groups and hospital systems to adopt this reimbursement model vs. standard fee for service, helps to improve quality outcomes for patients while making health care more affordable for all.

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