As the U.S. health system continues to grapple with rising costs, physician burnout and fragmented care, organizations are experimenting with new approaches to care delivery.
At CenterWell Senior Primary Care, one such approach is taking shape in cardiovascular medicine. The organization has developed one of the nation’s only cardiovascular practice models built entirely around value-based care—where physicians’ compensation is tied to their patients’ outcomes and experiences, not how many services they deliver.
For physicians like Evan Jacobs, MD, a cardiovascular disease specialist at CenterWell Senior Primary Care, the difference between this model and traditional cardiology practice became clear early in his career.
“Coming out of fellowship, I would meet with groups, and they would tell me how busy I was going to get and talk about my RVU [relative value units] structure and all of that,” said Dr. Jacobs. “But nobody was talking about how we were going to take great care of patients or deliver better health outcomes.”
In many traditional fee-for-service environments, he explained, incentives often emphasize physician productivity and the number of procedures. That structure can create pressures that compete with the core goal of patient care.
“There are a lot of perverse incentives in medicine,” Dr. Jacobs said. “If you’re not producing the RVUs that others in the group are, you’re kind of pushed to the back of the line. Everything ends up pulling away from what we’re all really here for, which is delivering great care.”
By contrast, CenterWell’s value-based cardiovascular model aligns the interests of patients, physicians and the organization around a single objective: better health outcomes.
CenterWell—which is part of Humana—is part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
“In our model, we have a full-risk primary care group that the cardiology team sits within,” Dr. Jacobs said. “Our margin comes from delivering an excellent patient experience and delivering really great outcomes. If we reduce low-value care and avoidable hospitalizations, that’s where the margin comes in.”
That alignment, he said, was the first time he encountered a system where every stakeholder was pulling in the same direction.
“Patients want good experiences and good outcomes. Cardiologists want to deliver thoughtful, evidence-based care,” Dr. Jacobs said. “And the organization wants good outcomes and patient engagement. This was the only model I saw where all of those things lined up.”
Fewer patients per day, more time for care
A defining feature of the CenterWell cardiovascular model is time. Unlike traditional cardiology practices that often require physicians to see large volumes of patients daily, the value-based model prioritizes longer visits and deeper engagement.
“It’s not a volume practice and it’s not based on RVUs,” Dr. Jacobs said. “We see a much lower number of patients per day, which allows us to spend time educating, counseling and addressing concerns.”
On average, cardiologists in the CenterWell model see about 12 patients a day—far fewer than typical outpatient cardiology practices.
“That allows us to really spend time with patients and educate, counsel, address and also have availability for emergent or urgent visits or walk-ins,” he said.
Diagnostics also play a central role in the model’s design. CenterWell has invested in advanced imaging capabilities.
“We built a robust imaging program with high-end equipment,” Dr. Jacobs said. “If you have high-quality diagnostics, you can make better decisions about what a patient actually needs.”
In many outpatient practices, he noted, financial pressures can limit the time available for imaging studies. “But at CenterWell, we can leverage our model type to enhance overall attention, quality and comprehensiveness.”
Virtual cardiology speeds patient access
Another distinctive component of the program is a virtual cardiology layer designed to streamline access to specialty care. CenterWell has designated virtual cardiologists who support multiple markets across the country. When patients are referred for a cardiology consultation, their case may first be reviewed through the virtual system.
In some cases, the virtual cardiologist can resolve an issue through peer-to-peer consultation with the referring physician, or by conducting a virtual visit with the patient.
“That can reduce what I call ‘time toxicity’—waiting for appointments, waiting for diagnostics and reducing the complexity of a patient’s journey,” said Dr. Jacobs.
If additional evaluation is necessary, the virtual cardiologist can prioritize patients for in-person visits or ensure that testing is completed before the first appointment.
“Sometimes we can order a stress test before the patient even sees the cardiologist,” Dr. Jacobs said. “Then when they come in, we already have the data and can focus on the plan.” That approach helps accelerate care and improve patient experience, particularly for people experiencing concerning symptoms.
Early data shows fewer hospitalizations
As CenterWell expanded the cardiovascular model to new markets, early results began to show measurable improvements in patient outcomes and cost of care.
“In the first year after launching the program in a market, we saw about 20% fewer avoidable heart failure hospitalizations,” Dr. Jacobs said.
Those reductions involve what clinicians call ambulatory-sensitive hospitalizations—events that often can be prevented through proactive outpatient care and chronic disease management. “We also saw about 15% fewer all-cause hospital admissions and a roughly 20% lower total cost of care,” he said.
Dr. Jacobs believes the model’s design contributes to those improvements in several ways, including closer collaboration between primary care and cardiology.
“Our cardiologists are also trained as internists. That means we’re looking at the whole patient,” he said. “It’s another checkpoint where someone's helping with blood pressure management or cholesterol management or lifestyle counseling.”
In practice, that can translate into better management of risk factors such as hypertension, cholesterol and lifestyle habits, extending beyond cardiovascular disease. “That’s why we see reductions not just in cardiovascular spending, but in total cost of care,” he said.
Reaching underserved communities
CenterWell’s value-based model also supports care delivery in communities that have historically faced barriers to access. Many of the organization’s clinics serve Medicare Advantage patients, including older adults in underserved areas.
“We’ve been able to make this model work both clinically and financially in places where others might not go,” said Dr. Jacobs.
In traditional fee-for-service systems, he noted, payer mix often influences where practices choose to locate. “In fee-for-service medicine, payer mix can determine where you open practices,” he said. “But our reimbursement structure is different.”
As a result, the organization can focus more directly on delivering high-quality care to populations that may benefit the most from coordinated, preventive services.
Engagement is the cornerstone
One of the most critical elements of value-based care is patient engagement, which “should be the number one priority for organizations like ours,” Dr. Jacobs said. “You cannot impact patients who don’t engage with the system.”
Because CenterWell assumes financial risk for patient outcomes, engaging patients in preventive care and chronic disease management is essential.
“In our model, the health care costs patients incur are also our costs,” he said. “So, we’re uniquely incentivized to engage people who might otherwise fall through the cracks.”
That outreach can take many forms—from phone calls and community engagement to partnerships with specialty physicians who help reconnect patients with primary care. For example, patients undergoing cancer treatment or dialysis sometimes rely primarily on specialists for care.
“We’ve built partnerships with specialties like oncology and nephrology to help bring those patients back into primary care,” Dr. Jacobs said. Those collaborations help ensure that patients remain connected to the broader care team, improving both coordination and outcomes.
Clearing up misconceptions about value-based cardiology
Despite growing momentum around value-based care, some misconceptions about the model persist, particularly among specialists who remember earlier attempts at risk-based payment. Historically, some cardiology groups operated under capitation arrangements in which physicians were paid a fixed monthly fee per patient regardless of services provided.
“That model often incentivized under-testing and under-treatment,” Dr. Jacobs said. “Groups might only see patients once a year or stretch out testing intervals. We've gotten rid of almost all of our capitation agreements with specialty groups, and definitely for cardiology.”
Today’s value-based care models are fundamentally different.
“This is not a model that is supposed to be restrictive about using resources or taking care of patients,” he said. “It is a model that is incentivized much more heavily on preventing bad outcomes and reducing low value care.”
In other words, the focus is on avoiding unnecessary procedures while ensuring patients receive the right care at the right time.
“We look at how much cost of care is avoided and how much outcomes improve compared with traditional models,” Dr. Jacobs said. “It’s about cost avoidance, not limiting access to testing or treatment.”
A path toward sustainable care
For organizations exploring similar approaches, Dr. Jacobs says the most important step is aligning incentives with the outcomes they hope to achieve.
“Health systems have to identify the levers that actually create value,” he said.
In cardiology, those metrics might include reductions in avoidable hospitalizations, improvements in patient experience and stronger engagement with primary care teams. Each specialty will have its own set of indicators that define success.
“The goal is doing the right thing for the right patient at the right time—not simply doing the most things possible,” Dr. Jacobs said.
Ultimately, he believes the transition toward value-based specialty care is essential for the long-term sustainability of health care in the U.S.
“We all recognize that the traditional model can’t continue indefinitely,” Dr. Jacobs said. “We can’t have a system that rewards doing as much as possible without always asking whether it’s necessary.”
While the model continues to evolve, he sees innovation and experimentation as critical steps forward. “Not everything in value-based specialty care is fully baked yet,” Dr. Jacobs said. “But we need to lean in, innovate and refine these models over time. It’s the only way our health system—and Medicare—will remain sustainable.”
Learn more with the AMA about value-based care, including ways to improve data sharing and best practices for payment methods.
