Succeeding in value-based payment: Choosing the right model

In an interview with Medical Economics at the ACP Internal Medicine Meeting 2025, Joshua M. Liao, MD, outlines three critical factors primary care physicians should consider when deciding between value-based care (VBC) models: staffing, technology and participation scale.

“You need the people,” 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. “If your staffing does not align to value-based models, it’s going to be difficult.”

He explained that success depends on whether staff have clear protocols for tasks like patient outreach and chronic care follow-up. “If your medical assistants… do not have policy and processes and workflows… around calling patients to close quality gaps,” he said, “that’s going to be hard.”

Second, practices need reliable tech infrastructure. “If you don’t have EHR systems… if you’re not able to get data back through referral loops… I think that will be hard,” Liao said.

Finally, scale matters. “If you have 5,000 patients or 3,000 patients, the variation statistically alone can dictate your performance,” he said. “You’re a little raft on a big ocean… to really get steadiness, you need to be a big boat.”

Smaller practices may need to join larger groups or networks to ensure sufficient patient volume and minimize performance volatility in value-based contracts.