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Value-based specialty care: 4 key lessons from Upperline Health

By
Navina Team
March 20, 2025
Value-based specialty care: 4 key lessons from Upperline Health
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Since value-based care first took shape in the U.S., a common assumption has been that primary care physicians are best positioned to drive its success. But what about patients who regularly see physician specialists rather than a primary care provider – or at least rely heavily on specialists? How can healthcare organizations and medical professionals make sure that these patients fully benefit from VBC? As value-based care evolves and questions like these arise, it is becoming increasingly clear that specialists have a critical role in the VBC ecosystem. 

To shed light on how physician specialists can make the most of value-based care, we recently hosted a fireside chat at ViVE 2025 with Dr. Christiana Beveridge of Upperline Health – the largest specialty-focused provider of VBC in the U.S. Drawing on Upperline’s vast expertise, Dr. Beveridge offered useful insights for anyone interested in the future of value-based care. Here are four key takeaways from our discussion.

VBC can empower physician specialists to improve patient care

Dr. Beveridge underscored both the benefits of value-based care (VBC) for specialists and the common hesitations that may make them reluctant to adopt it. The key to getting physician specialists on board, she explained, is helping them see how VBC enhances both their efficiency and their ability to deliver the best possible patient outcomes. Rather than adding to their workload, a well-structured VBC model provides seamless access to critical patient information and ensures that their recommendations are followed through.  

“If I’m a surgeon, I don’t want to make an uninformed decision about taking a patient to surgery. I want to know what are all the other things they have going on. Do they have heart failure? Are they on a blood thinner? Did they just get treated for pneumonia?” Dr. Beveridge said, noting that this need for a comprehensive clinical picture makes the interdisciplinary, team-based approach of VBC especially valuable for specialists.“The biggest hurdle is reframing this to, “Hey, you already do this. You already talk to your patient about their health history. Now you actually have information at your fingertips to document that appropriately, so you don’t have to ask them every single time [and] you don’t have to get your MA to request medical records. You’re already doing this; let’s help you do it better and faster.’”

In addition, Dr. Beveridge underscored that in much of the healthcare system, it’s common for specialists to urge patients to follow up with their general practitioners about various issues – recommendations that in many cases are at risk of slipping through the cracks. In contrast, a specialty-focused approach to VBC helps specialists ensure that their general health recommendations are addressed adequately. “This helps me make my treatment plan,” she explained. “It also helps me guide you and say, ‘Hey, I want you to talk with my nurse about diabetes. I have a care team behind me now that can help manage some of these conditions so that  I’m actually able to help you find a path to improving your outcome.’” 

Don’t underestimate the far-reaching impact of improved chronic disease management

Highlighting the importance of managing chronic diseases, Dr. Beveridge explained the key understanding that led to the formation of Upperline Health as a trailblazing organization at the intersection of medical specialties and value-based care. She noted that Upperline’s founders had previously worked for organizations that focused on end-of-life and palliative care within the model of VBC. 

“Being non-clinicians, they thought they were going to see a lot of people that were dying of cancer, stroke, dementia – but instead, what they saw was a lot of people dying of poorly managed chronic diseases. These are people who are falling through the cracks, who are not getting the appropriate care for their chronic diseases,” she recounted. “We can change that trajectory with the appropriate additional care and the appropriate intervention at the right time. What we’re doing is [getting] to these patients earlier through their specialist – who they’re going to already, and they respect – and [making] sure that we make each of those visits count for all the things that contribute to their overall health.’”

People, workflows, and technology: The 3 requirements for excellence in VBC

Taking a broad look at the challenge of shifting towards a value-based care model, Dr. Beveridge broke down the essentials for success into three categories: people, workflows, and technologies. 

“The only way to take risk on patients is to feel confident that you’re going to improve their outcomes over time, and that you’re going to be able to accurately document what’s going on with your patients. To do both of those things, you need to have people that use workflows that are enabled by technology,” she said. “If you don’t have all three of those elements, then you cannot run a successful clinic or business.”

Dr. Beveridge highlighted a fundamental distinction between Upperline Health and many other VBC organizations: the specialist-patient relationship. “The people are our specialists. And the reason they’re incredibly valuable is because patients have already developed relationships with those specialists. They’re already engaged,” she said. “They see them more than they see their primary care doctor. Remember, 30% of Medicare patients aren’t seeing a primary care doctor at all. So let’s use that specialist relationship and engagement as the benefit that it is.”

She also discussed how Navina’s AI copilot, combined with Upperline’s emphasis on preventative care, and multidisciplinary approach contribute to workflows that meet the needs of both specialists and patients. “That’s where we use AI. And specifically AI developed by doctors, because the doctors are the ones using it and the ones that need to trust it. It’s as if you had a resident there who went through all the medical records and pulled out the most important stuff and put [it] in the right order, like we’re trained to do – but instead, the computer does that,” she explained. “Lastly, we ask our [care] team to address preventative care gaps with our patients. Those can be addressed at any doctor’s office. They do not only need to be addressed at a PCP’s office.”

Bringing it all together, Dr. Beveridge underscored Upperline’s holistic approach to patient care.“[Patients] are more than just their foot, more than just their kidney, more than just their heart,” she said. “Let’s just help them do the things they need to do to stay healthy. And let’s allow our tech stack, workflows, and people make that happen.”

What it takes for AI to reach a 98% clinician adoption rate

Beyond emphasizing the importance of technology in streamlining workflows, Dr. Beveridge shared key lessons Upperline has learned from its experience with AI. She highlighted two essential factors that drive physician adoption and engagement: convenience and trustworthiness.

Dr. Beveridge shared that Upperline’s requirement for technology is that it should seamlessly fit into physicians’ workflows. “And it needs to be trustworthy,” she added. “We can’t have them finding things where they’re like, ‘Oh no, the data’s wrong.’ Because as soon as a doctor says the data is wrong, you’re out. You’ve got to climb back up this hill so slowly to convince them that the data is not all wrong.” 

Upperline’s results quickly validated this approach. Trust and ease of use led to rapid and widespread adoption of Navina’s solution among Upperline’s physicians. “The fact that it was trustworthy got people’s buy-in. The fact that it was easy made them try it in the first place,” she said. “Within four weeks of us rolling out this new product, we had 90% of doctors interacting with the system, and we had [an] 85% address rate, which means they actually looked at each condition. And within eight weeks, we had [a] 98% address rate.”

For a deeper dive into Upperline Health and Dr. Christiana Beveridge’s insights on empowering physician specialists to make the most of value-based care, watch the full video of our recent fireside chat.

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FAQ
How can software and AI help me boost my HEDIS performance?

Software can help health plans and other healthcare organizations improve their HEDIS scores – especially when that software has advanced artificial intelligence (AI) capabilities. In addition to saving time for clinicians, AI can help them raise the quality of the care they deliver – resulting in better patient outcomes and improved HEDIS performance.

AI-powered software can help identify care gaps by processing large volumes of data from electronic health records (EHRs), claims, and other sources. It can also examine unstructured data to close apparent care gaps in cases in which the required care has been provided but was not properly documented, as well as cases in which there is a specific reason that a given patient should be excluded from a certain intervention or type of care.

Through its use of automation, advanced software can increase the efficiency of these processes while helping to prevent errors and ensure adherence to specific guidelines. In addition, health plans and other healthcare organizations can use robust analytics to evaluate HEDIS performance among their primary care providers and identify areas for improvement.

At the same time, collaborative tools within software platforms can help clinicians streamline and improve their communication. This way, they can work more smoothly as a team to deliver patient-centered care, helping them improve both patient outcomes and HEDIS scores.

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What are different ways to incentivize providers to align with value-based care?

The transition to value-based care is a major shift, requiring significant work on the part of healthcare organizations and medical professionals. To encourage healthcare providers to align with the principles of value-based care, it is important to ensure that they understand why making this move is in their best interest. One key way to make that happen is to offer them meaningful, performance-based incentives. 

There are various approaches healthcare organizations can take to incentivize providers to excel in value-based care. The incentives can be financial (such as bonuses), but can also include non-financial benefits (such as paid time off). These incentives may be provided either to individuals based on their own performance, or to teams of medical professionals based on their collective performance as a group. 

One important question for healthcare organizations at the start of their value-based journey is when to start providing incentives to its medical professionals. The organization might opt to wait until it starts reaping the financial benefits of this shift before delivering performance-based rewards, so that the benefits it earns can cover the costs of the incentives it offers. But by starting to provide incentives in the early stages of the shift to value-based care, a healthcare organization can give its providers some extra motivation to embrace the value-based model – helping make the shift smoother and more successful.

Perhaps most importantly, when healthcare organizations use performance-based incentives to support their adoption of value-based care, they need to determine the metrics they’ll use to grant the incentives. They may set specific minimum thresholds that providers must reach in order to get a certain reward – or they may calculate rewards using a mathematical formula, so that providers who deliver the strongest results get the largest rewards.

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What are some of the challenges healthcare organizations face in the shift to value-based care, and how can they be mitigated?

Although value-based care offers significant benefits to patients, the transition from a fee-for-service model presents some major challenges for healthcare providers. Some of the biggest challenges include dealing with time-consuming (and potentially burnout-inducing) administrative work, navigating large volumes of disorganized patient data, and being understaffed.

There are some important steps that healthcare organizations can take in order to navigate these challenges successfully. For example, it can be very helpful to ensure that an organization’s leadership includes physicians. By having some physicians split their time between clinical and leadership work, organizations will gain a first-hand understanding of the day-to-day realities of treating patients. This input can be especially valuable when it comes to negotiating contracts, designing internal workflows, and evaluating possible organizational changes.

It is also crucial to ensure that healthcare providers have the tools they need to thrive within the context of value-based care. For example, HCC (Hierarchical Condition Category) coding is critical to risk adjustment, but the coding process can be very time-consuming. Providing physicians with a robust solution for streamlining the coding process can make a powerful difference. Artificial intelligence (AI)-powered tools can be particularly useful – helping ensure physicians do not miss any relevant HCCs, while also saving valuable work time and enabling them to focus more on providing high-quality care to patients. 

In addition, healthcare organizations can help physicians improve their performance by providing them with analytics tools enabling them to track performance in real time.

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