2024 VBC Summit Recap

What We Learned About the Future of Value-Based Care: Insights from Valtruis’ VBC Summit

Contributions from Jessica Bossmann, Paul Jansen, Callie Patel, and Claire McGee Sharma

Value-based care (VBC) has long been heralded as the future of healthcare — a model that emphasizes quality over quantity, prioritizing outcomes for patients and cost efficiency for the system. Yet, despite its promise and billions of dollars spent on its deployment, VBC adoption at scale remains elusive. At the 2024 VBC Summit, healthcare leaders convened to examine the barriers, opportunities, and future directions for VBC. The day-long session held November 13th in Washington, DC, encouraged open and honest cross-functional discussion on what’s working and what isn’t, with the ultimate goal to inspire collaboration on solutions that will shape the future of value-based care. Attendees included policymakers (including current and former leaders of the Centers for Medicare and Medicaid Services), VBC provider groups, health systems, and payors. 

Three overarching themes guided the Summit’s content:

• Barriers to Scaling VBC: From regulatory constraints to operational hurdles, participants explored the persistent challenges constricting scaled adoption.

• Innovative Models and Best Practices: Participants highlighted successful case studies demonstrating measurable outcomes and proof points in VBC.

• Policy as a Lever for Change: Attendees discussed actionable strategies to align incentives and accelerate VBC.

Despite the candid discussions, there were no simple answers. The complexities of VBC persist, and the Summit underscored the depth of those challenges. 

Here’s what we learned.

What Does VBC Mean Today?

To open the Summit, participants were asked to describe VBC in a single word. The responses were wide-ranging, from down-the-middle keywords like “outcomes” to the hopeful “solution,” and even betrayed some skepticism with terms like “buzz,” “detail-poor,” and “Sisyphus.” (Yes, meaning the Greek figure condemned by the gods to roll a massive boulder up a hill, only for it to roll back down each time he neared the top.) Their responses emphasized the evolving identity of value-based care, and its perplexing role as both solution and obstacle in our common pursuit of a better, more affordable healthcare system.

Breaking Down Barriers to VBC Adoption at Scale

During breakout sessions, Summit attendees identified barriers preventing VBC from reaching its full potential. These challenges can be grouped into four categories: 

1. Misaligned Incentives

• Many VBC models lack sufficient downside risk, diluting accountability and undermining quality.

• Voluntary vs Mandatory models have led to gaming within VBC models.

• Risk adjustment mechanisms can over-incentivize coding, leading to less investment in true care model evolution.

• The entrenched dominance of fee-for-service (FFS) creates resistance to change and makes the transition to VBC financially risky.

2. Short-Term Focus

• High churn in some markets incentivizes short-term ROI over sustainable, long-term value.

• There is often a need to prove savings in year one for models to demonstrate value to payors.

3. Model Complexity

• Inconsistent attribution, benchmarks, and quality measures erode trust and make scaling more challenging.

• Fragmentation across payors and programs complicates implementation and hinders a full population health approach.

4. Structural Barriers

• Regulations designed for FFS often limit or challenge VBC implementation.

• Implementing VBC requires significant investment in talent, technology, and infrastructure, often unattainable for smaller entities.

Reimagining the Role of Primary and Specialty Care

Our conversation then shifted to the role of “quarterbacks” in a VBC model. For most patients, primary care providers (PCPs) have the most visibility into the unique clinical needs of the individual beneficiaries and populations they serve. However, as more PCPs have high volume practices or are employed by larger health systems, there is less of a focus on them as the orchestrator of care. This is partially due to heavy patient loads required to make economics work in legacy FFS models, but also because the majority aren’t given the training, autonomy, or wrap-around tools to manage total cost of care effectively. 

It is generally accepted that there are also discrete, high-impact conditions like oncology, nephrology, or behavioral health (i.e., conditions that tend to completely dominate the patient’s relationship with the healthcare system) where specialty care providers should become the quarterback and risk holder. Other specialty areas are more episodic and alignment can be achieved via bundled payment models or sub-capitated value-based care arrangements.

Still, true integration of specialty care into a VBC framework remains challenging because a shift to VBC in many cases means a shift away from legacy FFS payment models that are largely favorable for specialty care providers, and for the health systems and hospitals where they practice. The true work to be done is finding ways to achieve realignment toward an incentive structure that favors quality and cost outcomes over volume.

The recurring theme in this conversation and others we had throughout the day is that at its core, the shift from FFS to VBC is a fundamental reordering of healthcare economics. This then begs the question, for VBC to succeed at scale, does the government need to play a more active role in incentivizing and/or enforcing the transition? Without the government as a referee, is there too much vested interest in maintaining the current system?

Proving VBC at Scale

Our concluding discussion cut to the heart of the matter, and focused on whether VBC is working at all. Participants debated its impact, noting that while programs like the Medicare Shared Savings Program (MSSP) have shown promise and CMMI models have allowed for experimentation and learning, widespread health improvements remain elusive and the industry’s goal of a fully integrated, patient-centered system favoring high quality and affordability remains more aspiration than reality. Key hurdles include:

• Inconsistent Success Metrics: The complexity of measuring success across diverse populations dilutes progress. Simplification and standardization of outcome measures are critical.

• Fragmented Accountability: Without clear lines of responsibility, many stakeholders lack the incentive to commit fully to VBC goals.

Actionable Insights for the Future of VBC

Participants largely agreed that immediate steps, such as incentivizing data sharing and streamlining quality measures, must happen now. A clear and transparent set of success measures and timely, freely flowing data to drive improvement will go a long way to reducing many of the barriers identified by this group, such as model complexity and resource intensity. One point of agreement among the group was that stability and predictability breed investment, a point underscored by the success seen in the MSSP program, which despite some changes, has been relatively stable since its inception in 2012. The ACO REACH program has some tenets of simplicity, around how quality is measured in particular, that are also driving stability and performance.  

One other point raised by multiple participants, with broad agreement, was that for VBC to truly succeed, it needs to move upstream from the Medicare population and be adopted more broadly among Medicaid and Commercial populations. Improvement in the health outcomes of this population has natural benefits that follow people into Medicare as well. Any long-term strategy must address the full spectrum of healthcare needs, from neonatal to palliative care, all using a consistent, straightforward set of measures and models. 

Priorities and Strategies:

• Simplify Quality Measures: Reduce provider burden by focusing on a few meaningful, claims-based metrics.

• Enhance Data Sharing: Real-time data exchange on total cost of care and quality of downstream providers should become the norm, not the exception.

• Value Capture: Enable stakeholders to capture the value that they create - giving credit to entities for avoided spend.

• Expand Focus Beyond Medicare: If success looks like a healthier population, we will need to emphasize the under-65 populations to maximize long-term health impacts.

The Path Forward

The 2024 Valtruis VBC Summit highlighted a paradox at the heart of the movement: while the theoretical value of VBC is clear, its practical implementation is daunting. The industry must address systemic barriers, reimagine care delivery roles, and focus on creating tangible, patient-centered outcomes.

Ultimately, the success of VBC will depend on our collective ability to simplify, standardize, and scale — ensuring that patients and providers alike experience the promise of a value-driven healthcare system. It’s hard but necessary work.

At Valtruis, we remain dedicated to supporting our portfolio companies in driving this transformation. We’re focused on partnering with service providers who bridge the gaps and investing in infrastructure that enhances data sharing, engagement, and ROI measurement. Together, we’re building a future where value-based care thrives.