By Steve Spencer
For decades, the American healthcare system rewarded volume over value — the more patients physicians saw, the more they earned. The result was a treadmill that left little time for the kind of thorough care that keeps patients out of hospitals in the first place.
That model is changing. Value-based care has gained momentum in recent years, driven by Medicare and major commercial insurers. In Birmingham, Complete Health is active in this transition, using Value-based care for its Medicare patients.
“We’re not just seeing patients for high blood pressure and giving them medicine and seeing them back in six months,” said John Farley, MD, CMO for Complete Health, who practiced internal medicine in Birmingham for 28 years before joining the organization in 2019. “We’re following up with them, whether we visit them, call them on the phone, or do telehealth visits. It’s a really different model.”
Complete Health has contracts with UnitedHealthcare, Viva Health, BlueCross BlueShield of Alabama, Cigna, and Humana, under which the organization receives a monthly fee to manage care for a patient panel. Rather than billing per visit, Complete Health is compensated for keeping those patients healthy. With approximately 120 providers in Birmingham, along with two urgent care clinics and several walk-in locations, the model is built around accessibility.
Value-based care patients have access to a dedicated 24/7 phone line — a separate 888 number they can call when problems arise. The goal is to keep patients out of the emergency room and the hospital.
“Bad things happen in hospitals,” Farley said. “We want to be proactive, engaging patients early in their illness, and making sure they’re current on their colonoscopies and mammograms. And when they have a problem, we see in our office quickly — because the longer you wait, the sicker you get. By the time you’ve waited four or five days for an appointment, you might be in the ICU by the time you get seen.”
To identify which patients need the most attention, Complete Health uses the ACG Hopkins model, drawing on data from both payer files and its own electronic medical records, to generate a ranked list of patients most likely to need additional services — whether that’s care coordination, a palliative care program, or more frequent outreach.
“It’s the 80-20 rule,” Farley said. “About 20 percent of our patients need the most services. We identify who needs to be followed and who doesn’t, then enroll them in these programs and follow them closely.”
The care team wrapped around each provider extends well beyond what a traditional practice offers. It includes care coordinators, a diabetes management program, palliative care led by nurse practitioners, and a transitional care department that reaches out to patients after hospital discharges. Inpatient navigators follow patients during hospital stays, all coordinated by a medical director who serves as, in Farley’s words, “air traffic control.”
For providers accustomed to fee-for-service medicine, the transition requires a shift in mindset. Farley, a fourth-generation physician, acknowledged that the old model created its own trap — the better a physician’s reputation, the larger the patient panel, and the less time available for each person on it.
“The thing that makes you good at the beginning destroys you in the end,” he said. “By then you’re seeing 40 people a day, you don’t have time to spend with them. In this model, it’s the opposite. Let’s make sure we’re addressing everything with these patients.”
Physicians in the value-based model typically see fewer patients per day, but earn more — shared savings from avoided hospitalizations and ER visits are distributed among providers who hit quality benchmarks. Farley said the model also helps address a growing concern across the profession: burnout.
“You’re able to spend more time with patients, discuss end-of-life planning, address things you usually don’t have time for during a typical visit,” he said. “And you get rewarded for outcomes rather than volume. That’s a significant change.”
Last year, Complete Health entered its first full-risk contract with BlueCross BlueShield of Alabama through its Blue Advantage PPO — the insurer’s first risk contract of its kind. More than a year in, both sides are satisfied. Conversations are also underway about extending the model to commercial patients, not just Medicare.
Looking ahead, Farley believes the financial pressure on the healthcare system will continue driving adoption. Earlier cancer detection, better management of chronic conditions like diabetes, and reduced reliance on expensive procedures all represent meaningful savings for a system straining under rising costs.
“If we can diagnose someone with cancer at an earlier stage where they don’t need $100,000 in chemotherapy, or help a patient lose weight so their diabetes goes into remission and they avoid an amputation — those are the kind of things we’d like to see,” Farley said. “The government’s going to look at that, and want to continue encouraging value-based care. It just makes sense to get rewarded for success rather than volume.”