![]() ![]() ![]() ![]() That is something that physicians remain reluctant to do. If the answer to either of those questions is "no," then they are looking at a big change. To be in a VBC model, they will have to join with other physicians. That will involve some loss of autonomy no matter what the model. So, a small PCP group may be offered a VBC contract by an insurer but they need to consult with an actuary to first see if they have enough lives to take on any “downside” risk. Generally, the more downside risk you are willing to take, the greater the upside opportunity is as well. Then the group has to determine, even if they have the right number of covered lives, do they have the ability to manage the care of those patients successfully throughout the whole continuum. Then there are subtle factors like the homogeneity of populations. Obviously, patients of similar geography and socioeconomic status are easier to manage for smaller groups. HL: Are doctors and hospitals reluctant to adopt VBC?ĭe la Torre: Change is a big deal. And VBC models are a big change that requires a big scale to support the TME risk and the cost of the infrastructure. It takes many PCPs to get an ACO going. Or they can be a smaller group with a decent-sized financial backer that is hoping to invest in the smaller group as a platform for growth. But the true “currency” of the VBC/ACO model is "covered lives." And basically, only PCPs get covered lives. The VBC model works best if the patient stays within the ACO that is handling the care. First, ACO is generally linked through the electronic medical record. Second, the providers in the ACO are out of the “click” mentality and are free to focus on the right care, right time, and right place. ![]()
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