Primary Care Transformation and Value-Based Outcomes in a Fee-For-Service Dominant Health System

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Document Type

Presentation

Presentation Date

3-31-2025

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Presentation: 50:59

Abstract

Large, integrated health systems continue to rely heavily upon fee-for-service (FFS) revenue to sustain financial viability. Both the reliance on transactional FFS revenue and the slow evolution of value-based contracting has delayed the investment in and development of the necessary infrastructure to support success in population health and value-based payment models. An additional challenge is converting existing, mature, high-volume provider practices, designed for success in FFS, to now perform well on value. Banner Medical Group piloted a team-based, primary care transformation model within 6 existing practice locations that included 24 providers with large, preexisting patient panels (mix of patients on both value-based and non-value-based insurance plans) to focus on value-based performance outcomes. Resources added included dedicated RNs, pharmacists and behavioral health providers, blocked clinic time for huddles and revised compensation models emphasizing value-based metrics. Key year-end, value-based performance measures were tracked over the first 2 years of the program (2023, 2024) and compared against baseline performance (year-end 2022), the overall medical group performance, and compared against the other providers at the same 6 locations who were not included in the care transformation model. Results reveal care transformation providers had higher patient experience scores, higher capture of risk adjustment score, lower risk-adjusted medical spending despite higher utilization metrics and higher primary care visit rates. Productivity improved despite increased emphasis on value performance, while quality outcomes improved across all cohorts. No halo benefit was seen for the providers practicing in the same locations who were not participating in the care transformation model. This demonstrates a viable path to improve value-based performance within an existing employed medical group, without adversely impacting provider productivity.

Language

English

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