If you’ve been in behavioral health long enough, “value-based care” (VBC) can sound like a moving target—part aspiration, part jargon, and part contract template. In a packed session moderated by Nate Hartmann (COO, Symetria Recovery), three operators who actually live with the consequences—Audrey Whetsell (CEO, Medical Home Group), Siobhan Morse (product director, SUD, UHS), and Eric Gremminger (CEO, ERPHealth)—made VBC feel both more concrete and more urgent.
From fee-for-service to risk—what the ladder really looks like
Whetsell opened by walking the room up the payment ladder: classic fee-for-service; fee-for-service with quality incentives; shared savings (upside only); bundles and two-sided risk; and finally partial/full capitation. None of this is theoretical—CMS wants the majority of payments in value-linked models by 2030, and commercial payers are already experimenting. Her practical warning: Your readiness is contract-specific and data-dependent. If you can’t prove the basics (who you served, what you did, what changed), start with incentives and shared savings before you chase capitated dollars.
Outcomes are the currency—just not one currency
Morse reframed outcomes as stakeholder-specific. Payers care about avoidable utilization and total cost of care; families care about stability and getting their loved one back; clinicians care about whether the care plan worked and how to improve it. Those perspectives are legitimate—and you’ll need to speak all three. She also pressed on infrastructure: Without data liquidity (claims + clinical + patient-reported + social determinants) and basic information exchange across community partners, it’s impossible to manage post-discharge events like med fills and follow-ups—the very metrics that drive VBC dollars.
Engagement beats length-of-stay
Gremminger—a clinician, founder, and person in long-term recovery—cut through the noise with a simple rule: The best predictor of success is length of engagement, not length of stay. His team’s decade of work shows why: When you continuously collect patient-reported measures, surface risks in real time, and keep people engaged after discharge (with accessible tools, multilingual options, and even light gamification), you not only personalize care—you create the proof payers require. He also made a practical point CFOs will appreciate: Preparing for VBC can still yield immediate ROI in today’s fee-for-service world (e.g., stronger UR packages tied to medical necessity, fewer avoidable denials).
What it will take to play (and win)
- Know your numbers—beyond finance. Average daily rate and margins matter; so do engagement rates, patient satisfaction, readmissions, and care-continuity markers. Exec teams need both dashboards. (Gremminger)
- Build for whole-person care, not siloed episodes. Either provide the continuum or contract it—but designate one accountable entity to coordinate and own the outcome. (Morse)
- Sequence your risk. Use incentive and upside-only deals as training wheels while you mature your data, workflows, and partnerships. (Whetsell)
- Be transparent. Quote your outcome denominators and limitations. Nothing erodes payer (or public) trust faster than glossy stats on 20% of your population. (Morse)
Equity is not an add-on
The panel repeatedly returned to equity as operational, not ornamental. If your tools don’t work for people with low literacy, in another language, or without reliable tech, you’ll measure the wrong population and miss the very events (ER use, readmissions) that drive cost. Designing for access is part of designing for value.
So, is VBC “real” yet?
Yes—and it’s uneven by market and model. The consensus on stage: Treat VBC less like a switch and more like a capability you grow. Start where your data can support you. Prove something narrow (e.g., timely follow-ups, med adherence, reduced readmits in 30 days). Earn trust, then take on more risk.
Hartmann closed with the most useful rule of thumb: At the core of all this is a moment between a vulnerable person and a prepared clinician. If your systems help that interaction be earlier, more personalized, better coordinated—and if you can show it—the contracts will follow.
