Succeeding in value-based payment: Keeping patients engaged

In an interview with Medical Economics following the ACP Internal Medicine Meeting 2025, Joshua M. Liao, MD, 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, offers practical advice for practices trying to keep patients engaged and connected in fragmented care environments.

Speaking about Medicare value-based models, Liao emphasized the importance of upfront communication and patient choice. “We can let the visit counts and everything sort itself out… or, better yet, prospectively before anything happens, why don’t we just acknowledge, hey, you’re my patient, right, and I’m your doctor, right?” he said. “You can go on the Medicare website… and you can actually, like, pick Dr. Liao as my doctor.”

That strategy — known as voluntary alignment — helps settle attribution early, minimizing ambiguity about who is responsible for managing a patient’s care.

He also encouraged physicians to be more intentional about referral networks. “If I’m a primary care doctor and I send you out for specialty care… and they never call me, send me a note, that’s where that problem about data becomes hard,” Liao said. “But if I know this clinician… is also going to send me a letter or call me—‘Hey, Dr. Liao, I saw [your patient]… I’m going to pass the baton back to you’ — that’s very helpful.”

Together, voluntary alignment and closed-loop referrals can help physicians maintain strong patient relationships and continuity of care, even across fragmented systems.