Succeeding in value-based payment: Aligning incentives for the whole team

In an interview with Medical Economics at the ACP Internal Medicine Meeting 2025, Joshua M. Liao, MD, explains how practices can effectively include non-clinical staff in performance incentives without creating unnecessary complexity.

“Healthcare is, in many ways, local,” said Liao, professor of medicine and public health with tenure, Walter Family Distinguished Chair in internal medicine, director and principal scholar, program on policy evaluation and learning at the University of Texas Southwestern Medical Center. “The goal of private leaders — a CEO, a COO, a medical director, a clinic manager — is to transmit [policy] down to the team or individual clinician level.”

While Medicare or private payers don’t dictate how shared savings must be divided, Liao emphasized the opportunity practices have through Accountable Care Organizations (ACOs) and other models. “There are certain funds that are fungible, meaning that the provider organizations or clinicians can decide what to do with them,” he said.

Some practices, he noted, have used that flexibility to reward the broader care team: “Of any dollar that we share, X percent… goes to medical assistants who help us call patients… to nurses that help us follow up and do medication triage, or pharmacists that help us do medication adherence.”

“The bottom line here,” he added, “is that there’s flexibility that I think is good. Then the question becomes… how do [leaders] want to use that flexibility?”

Liao said practices that include non-physician staff in shared savings programs often see strong buy-in and team-wide engagement.