Your 24-Month Game Plan for Value-Based Care
summary
In Parts I and II, we unpacked two big realities:
- CMS is not bluffing. By 2030, every Medicare beneficiary is expected to be in an “accountable care relationship.”
- Independent practices are exposed. Most small and midsized groups simply don’t have the care-management staff, data, capital, or contracting expertise to succeed in value-based care (VBC) as things stand today.
So the real question becomes:
What, exactly, should an independent practice do over the next 24 months to survive—and then win—in VBC?
This blog lays out a practical 4-phase roadmap
Phase 1 (Months 0–6): Stabilize Before You Scale
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Shore Up the Finances
VBC transformation costs real money—care managers, data tools, extra visit types, new workflows. Most offices run on a few weeks of cash.
Your first moves:
- Know your runway. How many days of cash on hand do you really have?
- Ask payers for infrastructure support. Per-member-per-month (PMPM) care-management fees, transformation dollars, or quality pre-payments.
- Explore VBC-aligned credit. Some lenders now peg repayment to future shared savings instead of fixed schedules.
- Protect the downside. Before any contract goes live, make sure you have stop-loss coverage, risk corridors, and clear attribution rules.
Think of this phase as putting the oxygen mask on the practice so you can safely take on risk.
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Get Basic Data & Attribution Right
You cannot manage what you cannot see.
In the first six months, aim to:
- Reconcile your attribution lists with each payer (who are “your” patients?).
- Get access to claims feeds (ED, hospital, specialist, pharmacy).
- Stand up a simple population-health view—even a basic registry is better than none.
- Establish a baseline for key metrics: ED visits, readmissions, A1c/BP control, total cost of care.
This is the minimum instrumentation you need before trying to fly the VBC plane.
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Tap Outside Resources
Tap outside resources so you don't pay for everything yourself.
You do not have to build all infrastructure in-house.
Look for:
- Plan supports: MA and Medicaid plans that offer data platforms, documentation help, embedded care coordinators.
- VBC enablers: Companies that provide shared care-management, analytics, coding, and reporting services for a fee tied to performance.
- Clinically integrated networks/IPAs: Shared staff and tools spread across many practices.
- Community assets: Federally Qualified Health Centers, churches, senior centers, food banks, housing agencies—partners who can help tackle social needs.
- Grants and pilots: HRSA, AHRQ, and CMMI programs that fund community health workers or behavioral health integration.
If you stitch these together thoughtfully, your practice doesn’t carry the full bill.
Phase 2 (Months 6–12): Build the Engine
Step 1: Move from Solo Heroics to Team-Based Care
Value-based care is impossible if everything depends on the physician.
By the end of year one, you should have:
- At least one care manager (RN/LPN or strong MA) focused on high-risk patients.
- Defined access to behavioral health (on-site or virtual).
- A plan to use community health workers (CHWs) to extend your reach into neighborhoods.
Weekly huddles around your highest-risk panel, recent ED users, complex chronic patients, social-risk patients, turn this team into a risk-mitigation engine.
Step 2: Build Physician Business Muscle
This is the part medical school never covered.
To protect your practice in VBC, you personally need a working grasp of:
- How benchmarks and total cost of care are calculated
- The difference between upside-only and two-sided risk
- What risk corridors, stop-loss, and minimum savings thresholds mean
- How risk adjustment drives revenue
You don’t need an MBA, but you do need basic fluency. Practices led by physicians who understand these levers consistently perform better than those that “leave it to the accountants.”
Phase 3 (Months 12–18): Integrate Care and Contracts
- Redesign the clinical model
Now it’s time to make sure your day-to-day medicine actually fits the payment model.
That usually means:
- Expanding beyond the 15-minute visit:
- Extended chronic-care visits
- Annual wellness visits that truly capture risk and function
- Nurse/CHW follow-ups
- Redefining Expectations
- Bake nutrition, movement, sleep, stress, and social context into routine care.
- Using Functional-Medicine-style tools
- Timelines, root-cause analysis, shared medical appointments help to prevent complications instead of just chasing biomarkers.
This is where real savings and better outcomes emerge.
- Become contract-literate (you can’t outsource this)
Attorneys are essential for legal language and compliance. But they can’t answer questions like:
- Are these quality targets achievable with my current staffing?
- Does this attribution methodology reflect my real panel?
- Are the chronic-disease metrics realistic for my population?
- Do I actually have the tools to hit these KPIs?
Only you and your clinical team can.
Going forward, every VBC deal should be clinician-led, attorney-supported.
You own the benchmarks, KPIs, and operational expectations; legal protects you on language and regulations.
Phase 4 (Months 18–24): Accelerate from Stable to Strategic
Once you have:
- Basic financial stability
- A functioning team-based care model
- Data you trust
- Some risk-adjustment discipline
- A couple of early contracts you understand
…you’re ready to move from survival to strategy.
That might look like:
- Expanding upside-only arrangements with more payers
- Taking selectivetwo-sided risk on panels where you know the population and performance
- Adding digital tools—RPM, CCM platforms, behavioral apps—to boost capacity without hiring a dozen FTEs
- Formalizing community partnerships to address food, housing, transport, and social isolation at scale
At this point, VBC stops being a threat and starts becoming an asset: a way to stabilize revenue, deepen relationships, and differentiate your practice in the market.
Why This Matters:
Independent Practices Can Outperform Big Systems
When they have the right support, independent practices often:
- Spend less per Medicare beneficiary
- Deliver equal or better quality
- Do a better job on trust, continuity, and cultural alignment
In other words, you are exactly the kind of practice CMS needs to hit its 2030 goals.
The problem isn’t that independent practices are “bad at value.” It’s that too many have been asked to play a high-risk game without capital, tools, or a playbook.
This 24-month Survival & Acceleration Framework is one attempt to change that.
What's Up Next
Part IV — The Good, The Bad, And The Ugly Of Value-Based Care
In the final post of this series, we’ll talk frankly about the parts of VBC that don’t work yet: payer accountability, contract quality, federal support, and what has to change so independent practices aren’t left carrying all the risk for everyone else.
Stay tuned—and if you’d like help mapping this 24-month plan to your own practice, that’s exactly what Practice Impact Partners was built to do.
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