September 8, 2026
You're Already Delivering Value-Based Care — You Just Aren't Paid for It Yet
By Walter Lin, MD, MBA
It's Saturday morning, and your phone rings. Mr. Wright has a cough, low-grade fever, and borderline low oxygen saturation. Since you're out with your family, the path of least resistance is especially tempting: send him to the emergency department and let the hospital sort it out.
Instead, you return the call, speak with the nurse to better understand what's happening, and order labs, a chest X-ray, and supportive care. A few hours later, you review the results, diagnose pneumonia, prescribe an antibiotic, and check on him again that evening, Sunday morning, and Sunday night. By Monday, he's improving — still in his own bed, cared for by people who know him.
Your efforts over the weekend took considerable time and medical expertise, but that work generated little or no reimbursement. Yet you delivered high-quality care and likely prevented a hospitalization, along with the delirium, deconditioning, and prolonged rehabilitation stay that so often follow.
Here’s the part nobody tells you: you just delivered exactly the kind of care that value-based care (VBC) is designed to reward.
We've been creating value all along
We've spent more than a decade talking about VBC as if it were a foreign destination whose language we must first learn before we're allowed to visit. But most of us are already touched by value-based initiatives without fully realizing it, such as through efforts to reduce hospitalizations, improve care transitions, and align care with patient goals.
The Centers for Medicare & Medicaid Services (CMS) continues to move Medicare toward models in which clinicians and organizations are accountable for both quality and cost of care. Yet the 2024 PALTmed Accountable Care Organization (ACO) survey found that most respondents weren't participating in an accountable care model, and relatively few were considering joining one.
The story we often tell ourselves is that we're not ready. I think we have that backward.
Strip away the acronyms and VBC is a simple idea: Instead of rewarding only the volume of services delivered, the payment model also rewards better outcomes and lower total cost. That should sound appealing to all of us practicing in post-acute and long-term care (PALTC) settings. We didn't choose this field because we love billing codes. We chose it to keep Mr. Wright safe, comfortable, and at home.
The good news is that the clinical skills VBC rewards aren't ones we need to develop. They're the skills we already have as experts in PALTC, skills that we use every day. We catch changes in condition early because an aide notices that a resident is eating less or a nurse tells us that she's sleeping more. We treat in place when it's safe, because the hospital can be dangerous for a frail older adult. We lead goals-of-care conversations so that care delivered matches care desired. We deprescribe medications that contribute to falls, confusion, and other adverse events. And we work with the interdisciplinary team — the aide, nurse, therapist, social worker, dietitian, pharmacist, and MDS coordinator — so important details don't fall through the cracks.
An important word of caution: Treating in place creates value only when it's the right clinical decision. Look again at Mr. Wright. He got labs, a chest X-ray, the correct diagnosis, the right antibiotic, and three rechecks across the weekend. Hospitalization was avoided only after determining that it wasn't necessary. The skill isn't simply keeping residents out of the hospital. It's knowing who can safely stay and who needs a higher level of care. Clinical judgment is what makes VBC work — and it must remain ours.
We've been delivering high-value care for years, but reimbursement hasn't always kept up.
The biggest gap is alignment
Here's the uncomfortable reality: Some of our most valuable work in medicine is being performed inside a payment system that doesn't reimburse for it. The biggest gap is usually not clinical competence. It's financial alignment.
Under fee-for-service, the time you spent taking care of Mr. Wright that weekend is nearly invisible. The avoided hospitalization generates no bill. The system pays generously when the ambulance comes — and sometimes nothing for the clinical work that safely makes the ambulance unnecessary.
That's the alignment problem: The clinical mission and the financial incentives don't always point in the same direction. Under the right value-based arrangement, that can change. When good care prevents unnecessary utilization and improves outcomes, some of the value created can come back to the clinicians and teams who generated it, supporting more staff, better access to data, stronger on-call systems, and compensation for work that fee-for-service often overlooks.
But that doesn't happen automatically. Clinicians should ask where the savings go and whether the people doing the work share in them. If your practice tells you that you're participating in VBC, it's worth asking a few basic questions — the sidebar (see below) is a good place to start.
Those questions matter because VBC isn't automatically good simply because it's called “value-based.” The model must support patient-centered care, sound clinical judgment, and fair alignment with the people responsible for delivering that care. Once you have the answers, ask whether the arrangement actually helps you take better care of your patients. If the model gives you useful data, resources, and aligned incentives, use them to strengthen the care you already provide; if it does not, raise those gaps with your practice or value-based partner. Clinicians should not simply participate in VBC — they should help shape it.
We're closer than we realize. PALTC clinicians have been creating value for years, often quietly and without recognition. The opportunity now isn't to reinvent good PALTC medicine. It's to join payment models that recognize and reward it.
Let's stop asking whether we're ready for value-based care and start asking what becomes possible when the payment system finally supports care that works.
SIDEBAR — Six Questions to Ask About Your Value-Based Arrangement
If your practice tells you that you're participating in value-based care, start here:
- Which of my patients are included?
- What outcomes and costs am I accountable for?
- What data and clinical support will I receive?
- What, if anything, should I do differently?
- If we succeed, how will the value created be distributed?
- How will the model protect appropriate clinical judgment when financial incentives and an individual resident's needs may be in conflict?
Walter Lin, MD, is the founder and CEO of Generation Clinical Partners, a medical practice dedicated to improving outcomes for PALTC patients. He also serves as treasurer on the PALTmed Board of Directors, chief clinical strategy officer of LTC ACO, and a member of the U.S. Department of Health and Human Services’ Physician-Focused Payment Model Technical Advisory Committee (PTAC).