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All of us can see glaring issues with the healthcare system that need to be addressed — but system-level change is hard. The leap to VBC isn’t easy, but the results are undeniable.
I practiced nephrology in eastern North Carolina for nearly 25 years. Like many of my colleagues, I went into medicine to give my patients the best care possible, helping them live longer, healthier lives.
But over time, the system began to chip away at my ability to fulfill that purpose. Growing administrative demands, declining reimbursement, the pressure to see more patients in a day, and a fragmented care delivery structure left little time for the kind of patient relationships and long-term impact that inspired many of us to enter the field.
That kind of longitudinal, patient-centered care simply isn’t supported by today’s dominant payment model. Most physicians practice in fee-for-service (FFS) environments that reward volume over value. The model is geared toward episodic care, incentivizing a high number of encounters rather than meaningful, continuous relationships. Reimbursements are tied to face-to-face visits, even though outcomes are often determined by what happens between them. And when a patient misses medications, struggles with transportation, or doesn’t understand their treatment plan, things can quickly unravel. Over time, even trust between the physician and patient becomes harder to build when the system rewards volume over relationships.