Essential strategies for value-based success in 2025

‍ As healthcare organizations continue their value-based journey, the ever-changing reality conspires to complicate their transition. With 2025 just around the corner, it’s worth giving some serious thought to the steps healthcare organizations can take in the coming year in order to maximize their value-based success. 

With that in mind, we recently teamed up with AMGA to host an insightful webinar – Thriving in Tomorrow’s Healthcare: A Roadmap for Value-Based Success in 2025 – which drew on the varied perspectives of:

• Dana McCalley, VP of Value-Based Care at Navina
• Dr. Vivek Garg, MD, MBA, Chief Medical Officer, Primary Care at Humana
• Dr. Yair Lewis, MD, PhD, Chief Medical Officer at Navina

The participants shared their strategies to help healthcare organizations adapt, improve patient outcomes, boost clinician satisfaction, and ensure their financial sustainability. 

In case you missed it, here are five important lessons from the webinar to keep in mind in 2025 (and beyond).

1. Expect 2025 to be a challenging year for value-based care

One major challenge for 2025 is the transition from the HCC V24 risk coding model to V28 – a shift that is already well underway. But V28 is but one of several changes in standards that will undoubtedly affect healthcare organizations, alongside the general trend of ‘raising the bar’ for value-based care over time.

“2025 is about perseverance. If you’ve made the commitment to truly change the value equation for the patients you serve, this is a challenging time. You’ve made investments. You’ve changed how your care teams work. You’ve built data and analytics. You’ve changed your contracting arrangements,” said Dr. Garg. “If we just take stock of the last year and a half, at least from a Medicare Advantage perspective, risk adjustment has changed. Stars and quality thresholds have gone up.” 

Dr. Garg also highlighted the urgency of the need to adapt to these changes. “We have a lot to work through over the next year. The journey we’ve all been on to essentially have high-performing, highly reliable practices and teams that reach outside the walls of our clinics and bear-hug our patients through so many different parts of their healthcare journey – that’s no longer a journey that we have a decade to pursue,” he explained. “We’ve got to keep making it work and progressing towards that value equation so that we can get there faster. Because the environment has changed in so many ways.”

2. To work well, value-based care requires strong teamwork

In addition to how value-based care changes dynamics between clinicians and patients, the webinar highlighted some of the ways it impacts the dynamics among clinicians and other employees. Because patients are treated more holistically under value-based care when compared to fee-for-service models, it creates an extra need for communication, cooperation, coordination, and collaboration. 

“Inevitably, in this value-based care journey, there are more people on our team or other teams that we’re coordinating with who need to do things with our patients or each other. That introduces a lot of complexity and day-to-day work: indication complexity, information coordination complexity,” noted Dr. Garg. “So orchestrating team-based care – a team sport, which is one of the core ways to move the needle on value-based care – is a fundamental challenge we have.”

3. Don’t underestimate the importance of clinician satisfaction

Given the challenges that can come with the transition to value-based care and the importance of teamwork within this model, it is especially important to keep clinicians’ morale high. With that in mind, Dr. Garg offered some specific examples of how Humana has taken concrete steps to help ensure clinician satisfaction. 

One step Dr. Garg described is having leadership that brings together physicians and operational professionals. “Every geography of our care teams has a physician leader and an operational leader that are essentially joined at the hip,” he explained. “[That’s] a leadership team that has reconciled the tensions that are inherent in doing patient care and trying to integrate all the different purposes that we do [it] for. Because they can all meld: you can reduce the total cost of care while improving patient care quality and outcomes, and meeting the standards of value-based care programs.”

Dr. Garg also discussed other steps that his team has taken to help ensure high clinician satisfaction, such as implementing a clinician experience survey and using its insights to make improvements. In addition to factors like competitive salaries and benefits, he emphasized the value of having mechanisms for “celebrating patient care stories” and helping clinicians feel recognized and appreciated for their work. “We’ve got to reactivate some delight and joy in practice – and make that not just talk, by being willing to invest in it in different ways,” he said.

4. Turning patient data from a hurdle into a tool 

In the day-to-day work of primary care physicians, dealing with large volumes of patient data is often a major challenge. When utilized effectively, that data can improve HCC coding, quality performance, patient outcomes, and clinician satisfaction. But making the most of that data can be an uphill battle. Not only are there often huge amounts of information for clinicians to process, but it’s common for that data to come from many sources, and for much of it to be fragmented and unstructured. That can make using patient data effectively a very time-consuming process – which is a problem, considering that time is the one resource clinicians most lack.

Dr. Lewis discussed this challenge, providing some valuable context. Reflecting on how much more advanced the state of medicine is today than it was in the past, he remarked, “There are more tests, there are more medications than have ever been available. [And] that’s great. We’re able to treat those diseases – [such as] diabetes, cardiovascular disease – better than we have ever been able to treat them. But on the other hand, the flipside of that is there’s just so much data. And although the state of interoperability is definitely improving … there’s still a lot of data that is either not being shared in the right format or is just unstructured.”

Dr. Garg also discussed the challenge of dealing with so much patient data and how Humana is taking steps to address it. “[Dealing with large volumes of patient data is] not reducing the total workload; it’s adding to it. People know it’s important, and yet we need to maintain our workforce, help them be sustainable, help them retain that time with patients. And so I think operational excellence [and] technology enablement are huge things,” he said. “We are investing in new technology platforms, and we are questioning how we use data and get it into the point of care, so that it’s most useful for our teams [and] so that we can expand the pie of what we do for patients, without essentially making people feel like it’s unmanageable.”

5. Patients should feel the benefits of AI

AI can be a powerful tool for helping clinicians deal with the vast amounts of patient data. But clinicians and healthcare organizations aren’t the only ones who should be able to tell what a difference AI makes. When they really tap into the power of AI, their patients should also feel the benefits of that technology. 

Dr. Garg discussed the importance of time and attention from the perspectives of both clinicians and patients, and how AI can benefit both parties by saving time for clinicians. “When I talk to our clinicians about why they joined our model – where they have smaller panel sizes but more complex patients and more that we ask them to do, and we hold them accountable [for] outcomes – they say they want the time with their patients,” he explained. “When we ask our patients what they value about our model, they say [they] value the time with our clinicians and care team members. And so, the ability of this technology to shift how we use our time and how our teams can use their time is the single most transformative thing we can do.”

For a deeper understanding of all of these key takeaways and more, please check out the webinar video on-demand.

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