Physician Champions: The Catalyst for Value-Based Care (“VBC”) Success

Healthcare has been moving steadily from fee-for-service to models that reward outcomes and patient experience. Government programs such as MACRA/MIPS and private payer arrangements encourage health systems to manage population health and reduce unnecessary utilization, but a surprising gap remains between value-based reimbursement and the way health systems pay their physicians. A cross-sectional study of 31 physician organizations in four U.S. states found that volume-based compensation remains the primary incentive for 93.3% of specialists; quality and cost-performance incentives represented less than 10% of total compensation. To close this gap, organizations need champions who can translate policy into practice and build compensation models that align pay with performance.

The Critical Role of a Physician Champion

Successful value-based programs depend on leadership. The physician champion should ensure that programs align with the three main goals of value-based care:

• Incorporate best-in-class healthcare pathways, improve clinical outcomes, and most importantly, create an environment that strives for high patient satisfaction (the “Triple Aim”). Without a respected clinician at the helm, value-based initiatives can appear abstract or imposed from above, making physicians less willing to change entrenched practice patterns.

• A strong physician leader helps bridge the divide between executives and clinicians, addresses fears about how new metrics will affect care, and persuades colleagues that value-based contracts are not a threat to professionalism but a means to deliver better care. In essence, the physician champion becomes the internal advocate who translates the language of population health into actionable steps for peers.

• The right champion should establish clear objectives, understand clinicians’ workflows and pressures, provide data analytics to support decision-making, and set realistic short-term goals so that a program can achieve “quick wins.” The physician champion’s personal interests should align closely with the initiative so they willingly invest their time and credibility and be able to balance their time commitment to value-based care programs with their clinical commitments to avoid burnout.

Aligning Pay with Performance

Why compensation reform matters

Although payers are adopting value-based contracts, physician compensation still predominantly rewards volume. My clients usually have physician compensation models based upon collections or RVUs before participating in value-based care models. Some continue that practice after joining VBC programs while others introduce (not easily!) a variable driven by a set of quality achievements.

Tailored base salary plus incentive models. The goal of successfully participating in these programs is to align the physicians' and ultimately the organization's compensation to their level of achievement of the "triple aim" of VBC programs. This type of model encourages clinicians' and organizational commitment to high-quality, coordinated care.

For example, I've encountered VBC compensation models that include a Plan of Care metric. A sub-metric that clinicians often struggle with is a plan of care for pain and depression. Some providers view this as a purely administrative step, essentially just clicking radio buttons, without considering the downstream impact that incomplete documentation can have on their VBC achievements, MIPS performance, and their NPI for years to come. One-on-one discussions between the clinician and physician champion promote better understanding and noticeable improvement in performance.

Start small but grow meaningful incentives. Organizations that are new to value-based compensation often begin with a modest flat amount or percentage of pay tied to quality. The plan should be designed so that the base salary doesn't decrease during the early implementation stages. Over time, compensation plans should increase the percentage of total compensation that is determined by achievements, both individually and as a group, in VBC programs. I've seen practices start with percentages as low a 2% or flat amounts of $10,000 and gradually increase up to 30% or $50,000 or more per year.

Use group quality metrics when appropriate. Individual performance on quality metrics can be confounded by patient mix and other factors. Group quality metrics foster team-based care. Overall, measured quality metrics should align the responsibility for achieving a result with the ability to do so. For example, documenting a plan of care for pain and depression falls clearly in the clinician's wheelhouse. On the other hand, achieving metrics tied to emergency department visits, inpatient stays, and readmission rates are usually a group effort.

Monitor performance with dashboards and adjust annually. Success in value-based care programs isn't a "build it and forget it" project. Healthcare in general and VBC programs are continuously evolving and so must an organization's VBC compliance program. The challenges are daunting and sometimes overwhelming. For example, successfully targeting emergency department and inpatient events often is hampered by the lack of consistent, real-time data from hospital and patient notifications, as well as standardized staff documentation in the chart.

Some challenges require "groupthink" to overcome. For example, a goal to reduce fever- and infection-related admissions might be best addressed through a multidisciplinary Quality Improvement Program. The American Society of Clinical Oncology certification program ("ASCO Certified") Standard E.2 states that "a practice demonstrates a commitment to quality improvement by regularly using data to evaluate a process of care, implementing changes if/when indicated from analysis, and monitoring sustainability of improvement over time." Furthermore, "The goal of quality improvement in health care is to improve the overall care and outcomes for patients and providers. Quality improvements are the actions taken, processes implemented, or services created to improve cancer care."

Conclusion

Value-based care is a marathon, not a sprint. Regulatory mandates and payer innovations are accelerating the shift, but true transformation happens inside organizations when compensation aligns with mission. Physician champions are indispensable: they mobilize clinicians, translate administrative goals into clinical practice, and sustain momentum. Aligning pay with performance requires a hybrid compensation model that rewards outcomes, patient experience and team-based care while maintaining sufficient stability to support physicians through the transition. When leadership invests in both the human element (physician champions) and the structural element (strategically aligned compensation), value-based care becomes not just an external mandate but the organization's operating philosophy.

📊 At a Glance:

• Volume‑based physician pay undermines value‑based care goals.

• Physician champions connect administrators and clinicians to drive patient‑centered change.

• The Triple Aim targets better care, better population health and lower per‑capita costs.

• Hybrid compensation models and physician engagement are key to aligning pay with outcomes.

Citation(s): Reid RO, Tom AK, Ross RM, Duffy EL, Damberg CL. Physician

Compensation Arrangements and Financial Performance Incentives in US Health Systems. JAMA Health Forum. 2022;3(1):e214634. doi:10.1001/jamahealthforum.2021.4634