Seeing momentum for value-based care | HLTH 2025

Las Vegas - After years of hype and hope for value-based care, Dr. Chris DeRienzo sees growing momentum.

The chief physician executive of the American Hospital Association, DeRiezno says that he’s optimistic about the prospects of value-based care. Health systems are going to have to find ways to keep people healthier, and ensure hospitals have the capacity to treat those who truly need acute care.

DeRienzo moderated a panel on value-based care at the HLTH Conference in Las Vegas. After the panel, he talked with Chief Healthcare Executive® about value-based care and the need for innovative approaches.

“I'm really excited when I talk to folks who are just entering medicine or nursing or anywhere in the healthcare ecosystem now, because we see these twin engines of a drive to improve and innovation coming together in really meaningful ways,” DeRienzo says.

“We hear about it with the technology-enabled solutions at conferences like this,” he adds. “I see it all over the place in hospitals I visit, large and small around the country. This need to serve our communities is a really deep and passionate driver of everything that we do in hospitals and health systems. So, I honestly could not be more optimistic about what we see through the windshield here in the years ahead.”

Part of the reason for the need for transitioning away from fee-for-service models is driven by demographics. America’s population is aging, with thousands of people enrolling in Medicare every day. The last of the Baby Boom generation will be 65 at the end of the decade, and America’s health systems are going to be caring for more people who are older, and will likely need more care.

That’s why DeRienzo says it’s critical to find ways to help people stay healthier and manage chronic conditions more capably before they need a hospital stay.

“We're in the middle of a generation who is aging into their higher utilization years,” DeRienzo says. “That said the generations who are in the workforce to serve them are smaller.”

Still, value-based care models must be financially viable, and DeRienzo says moving away from the fee-for-service world isn’t easy.

“I do still worry about sustainability under population-based payment models in parts of the country where demographics are shifting,” he says. “We’ve seen challenges reflected in that.”

“When I think about hospitals, we are both a pillar within but also a reflection of our communities,” he continues. “And I think you just you can't just take a mandatory model and implement it everywhere at once and expect it to work. I worry about sustaining access to care with that approach.”

Health systems employing value-based care rely heavily on primary care physicians, and fewer doctors are going into primary care. DeRienzo says hospitals and health systems need to develop more primary care options to help patients stay healthier.

“I'm seeing our members innovate around primary care in lots of different ways, some in an integrated fashion where primary care is part of what they do others, in partnership with independent primary care providers,” DeRienzo says.

One health system is addressing the challenge by devising different models of primary care aimed at different populations.

That approach has benefits for patients and physicians, he says.

“As a doctor, I might both enjoy and be better suited to practicing in that extensivist environment, where you're spending an hour in every visit with this incredibly complicated chronic challenge that a patient is facing,” he says. “Or I may like the quick turnover of all you need is a quick check in.”

“I think when you are positioned to be able to provide different solutions for the different folks who need them, that that is one upside of the innovation that I'm seeing kind of wash across the country right now,” DeRienzo says.

Some of the challenges come in rural communities, where there may be only one small hospital within a radius of 50 or 100 miles. He mentioned one rural hospital during the panel that typically has a patient a day.

“When I think about the versions of -based care and payment that has historically existed, trying to apply that in that kind of a community, it's just not going to work the same way as an integrated health system that has been working in population-based payment for decades in a highly populated region,” DeRienzo says.

The successful development of value-based care has to reflect the realities of the particular needs of communities, he says.

“You just can't have a one-size-fits-all model,” he says. “And I think when we push folks into that model, we can set them up for failure. And we know that at least in our world, failure looks like decreasing access to care, and that I don't think we can afford.”

However, rural hospitals have demonstrated a keen ability to innovate, perhaps out of necessity in managing limited resources.

DeRienzo pointed to a rural hospital in Kansas that has found novel approaches with a small staff.

The hospital has a telehealth partnership with a larger health system that provides expertise in dealing with trauma. Staff at the small hospital press a screen and are connected with emergency physicians and nurses who can offer guidance and help guide the hospital in caring for the patient or stabilizing the patient for transfer.

“I said to myself, that’s what innovation looks like,” DeRienzo says.