This presentation examines the challenges of implementing value-based care (VBC) in integrated healthcare, including misalignment between payers and providers, inadequate behavioral health metrics, and complex payment structures. A national survey conducted in Fall 2024 (n=50) highlighted key provider concerns, such as contractual clarity (42%), poor state/payer engagement (32%), and misaligned metrics (32%). While financial incentives (50%) and practice flexibility (46%) motivated VBC participation, unclear incentives (22%) and reporting burdens (24%) remained obstacles. The findings underscore the need for stronger provider-payer collaboration, standardized quality metrics, and better education and training. This session will offer practical recommendations to improve VBC adoption, ensuring financial incentives align with patient-centered care.
Rachel Bembas PhD, Principal Consultant, Health Management Associates, Clifford Twp, Pennsylvania
Chris Botts BS, Senior Manager, Care Delivery and Payment Physician Practice Sustainability, American Medical Association, Washington, DC
Neftali Serrano PsyD, Chief Executive Officer, Collaborative Family Healthcare Association, Chapel Hill, NC
Leão, D. D. L., Cremers, H.-P., van Veghel, D., Pavlova, M., Hafkamp, F. J., & Groot, W. (2025). Design, implementation, and evaluation of value-based payment models: A Delphi study. BMC Health Services Research, 25(1), Article 116. https://doi.org/10.1186/s12913-025-12281-z Maruthappu, M., Hasan, A., & Zeltner, T. (2015). Enablers and barriers in implementing integrated care. Health Systems & Reform, 1(4), 250-256. https://doi.org/10.1080/23288604.2015.1077301
Porter, M. E. (2019). Quality metrics and value-based care in medicine. Harvard Business School Working Paper. Retrieved from https://www.isc.hbs.edu/Documents/pdf/quality-measurement-in-health-care-HLS.pdf
Peikes, D., Swankoski, K., Taylor, E. F., O’Malley, A. S., & Day, T. (2019). The effects of a primary care behavioral health model on patient experience and outcomes. Journal of General Internal Medicine, 34(3), 340-347. https://doi.org/10.1007/s11606-018-4737-7
Fisher, E. S., Shortell, S. M., Kreindler, S. A., Van Citters, A. D., & Larson, B. K. (2012). A framework for evaluating the formation, implementation, and performance of accountable care organizations. Health Affairs, 31(11), 2368-2378. https://doi.org/10.1377/hlthaff.2012.0544
Zonneveld, N., Driessen, N., Stüssgen, R. A. J., & Minkman, M. M. N. (2018). Values of integrated care: A systematic review. International Journal of Integrated Care, 18(4), 9. https://doi.org/10.5334/ijic.4172