Why Value-Based Care is the Answer Our Healthcare System Needs

By Tyler Jung, M.D., Chief Medical Officer of Greater Good Health

The U.S. healthcare industry is at a crossroads. Despite spending more on healthcare than any other high-income country, the United States ranks last in health outcomes, including lower life expectancy and higher rates of death and disease. The Commonwealth Fund issued an alarming report in 2024 that depicts what a dire state our healthcare industry is in, and while the data is important proof, the shortcomings of our system have been widely known and discussed for some time.

Existing challenges

I am willing to bet you have your own account of healthcare frustration, whether it is difficulty scheduling an appointment with your provider, expensive bills for specialist visits or procedures, or just a negative patient experience overall. Unfortunately, primary care, a vital need given its focus on general wellness and prevention, is one area that is struggling the most. Research shows that by 2036, there will be a shortage of up to 40,400 primary care providers across the country. The impact of this shortage is significant because when people aren’t visiting a primary care provider, they are not getting preventive care – leading to much worse health down the road – or using urgent care or the emergency room for routine visits, which is unsustainable from a cost perspective.

Healthcare’s solution

While it’s easy to focus on what isn’t working, there is a solution that helps improve outcomes and patient experiences while also lowering costs: value-based care. Let’s take a step back to orient around the traditional model our health system operates within: fee-for-service. Just as it sounds, the fee-for-service model is highly transactional and is structured in a way that prioritizes volume of services over quality of care. That is, providers are reimbursed for appointments, tests and procedures, and the quality of care provided is likely to be variable because it is not reimbursed. To be clear, this is not a criticism of individual providers or practices that operate a fee-for-service model; the system was designed this way, and hardworking healthcare personnel do their best to provide good care within it.

However, we know and now have proof that value-based care is a better way to operate, focusing more on quality care and appropriate care, creating cost accountability by incentivizing when patients do well, leading to a better system for patients, providers and payers. With value-based care, providers are taking on financial risk, which means that they get paid a set amount of money per patient to keep them healthy. This incentivizes proactive care, which may look like more frequent and longer appointments, a greater emphasis on routine screenings and simply a stronger relationship between provider and patient.

Primary care, which is essential to keeping people healthy, can especially thrive in a value-based care model. My example of the care Mr. Roberts received was a direct result of value-based care. Our team was given the time and resources to be able to build the relationship, create the plan, and importantly, follow up consistently to ensure Mr. Roberts stuck to the plan and came back to visit us. This is how it all comes together and really moves the needle on experience and outcomes, all while lowering costs.

You may be wondering, if value-based care is a proven way to deliver better healthcare at lower costs, why isn’t our entire healthcare industry operating that model? It’s a great question. In my next blog post, I will explore this question and help answer why the transition from the legacy fee-for-service model to a value-based care model is so complex for healthcare providers nationwide.

About Greater Good Health
Greater Good Health is a premier partner for risk-bearing organizations in managing total cost of care. The company is enabling and expanding access to value-based primary care through its innovative suite of clinical solutions and its own primary care clinics for seniors in underserved communities. Greater Good Health’s proven Nurse Practitioner-led model reduces unnecessary costs, improves clinical outcomes and delivers a best-in-class patient experience.

For more information, visit www.greatergoodhealth.com.