In this episode, Dr. Shannon Decker, Founder & CEO of VBC One, explores how value-based care aligns with financial success and shares strategies that create meaningful, lasting impact.
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Learn how to listen to The Hospital Finance Podcast® on your mobile device.Highlights of this episode include:
- What VBC One does
- How VBC One helps health plans and provider groups succeed in value-based care
- Defining value-based care in 2025
- Biggest opportunities and pitfalls for hospitals trying to move deeper into risk-based arrangements
- Practical steps to prepare for delegated risk or shared savings contracts
Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome Dr. Shannon Decker. Dr. Decker is the founder and CEO of VBC One, a consulting firm that partners with physician groups, health plans, and vendors to optimize value-based care performance. With over 25 years of experience, including 17 and risk adjustment, quality, and Medicare, she brings deep expertise in healthcare strategy, analytics, and operations. A published author and national speaker, Dr. Decker currently serves as a RISE Fellow and on the faculty at Capella University. In this episode, we’re discussing Value-Based Care Meets the Bottom Line – Financial Strategies That Drive Meaningful Impact. Welcome and thank you for joining us, Dr. Decker.
Dr. Shannon Decker: Thanks for having me, Kelly. Glad to be here.
Kelly: We’re glad to have you. Well, let’s go ahead and jump in. So, what does VBC One do? And how do you help health plans and provider groups succeed in value-based care?
Dr. Decker: Sure. Happy to share that. So, before VBC One started, I had spent years managing value-based care programs and clinical performance for medical groups and health plans and saw a need for smaller groups that needed these types of services. And so, we provide fractional operations support for medical groups that are taking risk, risk contracts, doing work in quality performance, clinical programs, total cost of care, and trying to manage patients in these value-based arrangements. And then we work with health plans as well too. But all of those operational needs that you may not have staff for; we can come in and provide either a little or a lot.
Kelly: Sounds great. Thank you for sharing that with us. So, how do you define value-based care in 2025, especially as it relates to the financial performance of hospitals and health systems?
Dr. Decker: So, I think that’s a great question. And when I think about value-based care and why it’s important in 2025, when I think back to 1980 and we look at a census graph, we know that there were more 20, 30, and 40-year-olds on this planet than there were 80-year-olds. But through medical advancement, technology, the great pharmaceuticals that we have at our disposal today, and all of those advancements, if you look at– fast forward to 2020 and look at census graph at that time, you can see that now there are as many 80-year-olds as there are those 20, 30, and 40-year-olds. In fact, we know that today there are more people over the age of 60 on this planet than there are under the age of 5. And while medical advancements and all that we’ve done through pharmaceuticals have helped us to live longer, it doesn’t necessarily mean that we’ve been living healthier. So, there are more people on this planet with the ability to– that have lived longer that we now need to take care of. We also know that we have a shortage of primary care physicians in this country and that we need someone to be able to take care of those patients. And so, value-based care, in my mind, really arose out of this need of how do we take care of all these people and do it in a way that makes sense in healthcare and doesn’t tax the system.
And so, I think a value-based care is this need to– or the solution for how do we get to the quintuple aim. And the quintuple aim– and I know I’m going to simplify it beyond what it was originally, but it’s the right care at the right time for the right price. And then importantly, don’t burn out our physicians. And how can we offer those healthcare services in an equitable manner? And we wouldn’t be able to do that unless we started thinking differently about healthcare. And so value-based care is really, how do we manage patients, provide the preventative care that’s necessary, that hopefully they won’t need the additional care and medicines and things like that to keep them going, but rather we can actually disrupt the trajectory by encouraging them to practice and participate in preventative measures, make lifestyle changes, how can we manage them appropriately and make sure that they’re accessing the appropriate sites of care? You may not need to go to the emergency room for the flu, but you could get a same-day appointment with your physician or you could go to an urgent care or tap into an after-hours service. And so, managing cost in that way to make sure that we’re seeing the appropriate patients, yeah, and keeping healthcare moving appropriately.
Kelly: Yeah, I really like that definition, Dr. Decker. Thank you for sharing it with us. So, from your perspective, what are the biggest opportunities and pitfalls for hospitals trying to move deeper into risk-based arrangements?
Dr. Decker: That’s a great question. And I really think that it requires a mind shift. When I think about hospitals moving into those types of relationships, I think it’s important to form good connections and relationships with the medical network within your region. So, making sure that you’re connecting with health plans, making sure that you’re connecting with your specialists, your primary care physicians, and being active in those discussions. But I also think one of the pitfalls, and what I find in groups that are engaging in risk-bearing arrangements, is that they need to make an honest assessment and understand that value-based care and being successful in it often requires a change of mindset. And so, you can’t operate in that fee-for-service mindset any longer where the patient presents to you, you care for them, they leave, they go on their merry way. But what are ways in which you can engage with them and again, make sure, and I think for hospitals, that they’re accessing healthcare appropriately? For example, there are opportunities– there’s been a big movement in the last couple of years around hospital at home. Are there opportunities where you can provide care at home? Often, it’s more comfortable for the patient. They get to be with loved ones. And so, there’s other benefits that come out of that for the patient’s health, but also to managing a patient at home can be less expensive. And so, there’s an opportunity to control costs there and then saving beds in the facility for those patients that really need them.
But I think it’s really understanding that just because the patient presents in the emergency room and then they’re going to be admitted, right, really thinking about what’s the level of care that’s needed, what’s the appropriate site of care that’s needed, are there ways to triage that patient, maybe back to, again, an after hour service, an urgent care. All of these types of strategies are ways in which you can perform successfully, control for cost. So, make sure that the patient is getting the appropriate care and the appropriate medical outcomes, but gives you an opportunity to perform better in those risk contracts. And I know that that’s a different way of thinking because in the past, we encourage people, right, to come in and to have those appointments. But this is really thinking, I think, more longitudinally of how we can improve health and again, making sure that they’re accessing healthcare appropriately.
Kelly: Yeah, no, that makes a lot of sense, Dr. Decker. For organizations that feel hesitant or overwhelmed, what are a few practical steps they can take today to prepare for delegated risk or shared savings contracts?
Dr. Decker: That is a great question. And I see a lot of groups– a lot of folks enter into these contracts, and they’re excited. The health plan’s excited. Everybody wants to get involved and believes in the mission of these contracts. But you really need to take an honest assessment of yourself and understand what your capabilities are. And so, if you don’t have the technology that’s needed maybe to manage a certain component of the contract, don’t feel that it’s a weakness to call that out during negotiations. I think it’s important. Everyone wants to be successful. And I’ve worked with a lot of medical groups. And one of the things that we’ll do is we’ll identify what are the areas, what are the components of that contract where we think we can have an effect and where we don’t. And sometimes there are things that are put into that contract. They’re more boilerplate templated contracts that you can push back on. And folks need to think through whether or not they can have an effect. And you certainly don’t want to have things in that contract that you’re responsible for if you can’t have an influence on them. The other thing I would say is, you don’t have to go in leaps and bounds. You don’t learn to run a marathon by being a couch potato. You don’t go from getting up off the couch and going out and running. It takes practice and it takes trial and error.
And so, the same thing with a risk contract too. Maybe you don’t want to do global risk right away. You want to start small and there might be certain components that you want to partner with a health plan on and first demonstrate your success there. Have those small successes. And then success stacking, I guess you would say, or behavior stacking, habit stacking, where you do well with one piece, and then you continue to build on it until you have a successfully functioning, well-functioning program that you don’t feel overwhelmed by. So, baby steps.
Kelly: Thank you for providing those steps. Those were very practical and implementable steps. Can you share how technology is changing the game, whether that’s through better coding support, AI, or data analytics?
Dr. Decker: Oh my goodness. I think–
Kelly: Loaded question, right?
Dr. Decker: –that technology– I know. It’s just been a watershed with all the developments around technology. And I think that– so this is what I would say. There are amazing things out there and there’s all sorts of support that you can get around technology, but make sure that you’re doing your due diligence and that you are diving in, asking those critical questions, and making sure that that technology gets you what you need, and have an honest assessment too. You don’t have to buy the minted technological advancement. I always laugh and tell people you don’t need the Ferrari maybe right away, especially when you first get your driver’s license. You don’t even know how to handle that car. And the Hyundai, no offense to Hyundai owners– and I don’t even know if they still make Hyundais, but it’ll get you from point A to point B, and that might be all you need. And so do an honest assessment and then make sure that you’re doing your diligence just because a sales representative tells you that it can do something, make sure that you have folks advocating on your side that can help you make that assessment and understand where the potential challenges may be.
Kelly: No, I love that analogy. That was awesome. Thank you. So, what policy or payment changes in 2026 do you think will have the greatest impact on hospital finance leaders?
Dr. Decker: I would say pay attention to what is going on around risk contracts. And then I know that there’s been a lot of developments. Even in the last administration, there’s been a focus on looking at hospital spending. And I think one of the things that folks recognize is that you do need the support of your hospitals, especially in controlling cost. I think of value-based contracts, and I’ve been around for a long time, and we started with primary care, and now it’s moved into specialty care, and we see more and more moving into hospitals. And now you have new programs, like I said, like hospital at home, but you also have the teams program, the head model, and then now they’ve introduced some new care because they’ve recognized, right? There’s a reason why they called out, it was musculoskeletal, and I think back problems, and forgive me, but there’s a new program around conditions that we know are seeing a lot of time in hospitals and drive excessive cost when they don’t need to. So, I would say be aware of those programs that are coming out. There’s a lot of programs, more maybe in the past that were piloted, but we’re still seeing some come out from CMMI, which is the Innovation Center through CMS, those programs of, again, trying to redirect care from hospitals if it’s not necessary. If you can do a knee surgery, right, a simple knee surgery at an ASC, right, then divert care there. Or I know one of the things that we look at when we look at our contracts too is analyzing is it appropriate for a C-section? Is there a high C-section rate? And in some areas, it’s appropriate, right?
And in those instances, you challenge that because that’s what patients need. And we always want to make sure patients are getting the care that’s necessary. But those would be some things that I would look at. Keep attuned to those programs that are coming out and the developments around risk adjustment around quality and about monitoring total cost of care, looking at medical loss ratios, and making sure that, again, that patients are getting the appropriate, they’re accessing the appropriate side of care would have the most implications.
Kelly: That makes a lot of sense. Thanks for sharing your thoughts on that with us. Finally, how can hospital teams measure success beyond ROI? Ensuring that financial sustainability also drives better patient outcomes and provider satisfaction.
Dr. Decker: That’s a great question too. And I do think that we need to look at other key performance indicators. So KPIs beyond ROI. And I know that’s difficult sometimes, but there are other types of capital that one should be measuring. And one of the things too that I know that our healthcare system and our policymakers are attuned to is that our patients, our all patients, are they provided equal access to care? And so, we know that there are certain socioeconomic groups that are put at more of a disadvantage than maybe others. And so, taking a look at that, how are you doing with reaching the populations within your neighborhoods? Are they accessing care, getting the appropriate care as needed? What are the various mortality rates or complication rates around that would be some things that I would look at. Provider satisfaction I think is really important. We know that we have a physician shortage in this company– or in this country. And then again, knowing that people are living longer, but not necessarily healthier. What are we doing to maintain our physicians? We know we have an overage of nurses. How are your nurses doing in your system? How are you caring for them? And are there ways through job satisfaction that you might be measuring that you could be using them at the top of their license or in other ways, right, to help care for these patients that we know are coming our way?
Kelly: Wow. Well, thank you so much for joining us, Dr. Decker, for sharing your insights with us on Value-Based Care Meets the Bottom Line – Financial Strategies That Drive Meaningful Impact. Thanks again.
Dr. Decker: Thank you.
Kelly: And if a listener wants to learn more or contact you to discuss this topic further, how best can they do that?
Dr. Decker:The best way would be to send us an email at info@vbcone. That’s VBC One dot com, or you can reach out to us on LinkedIn. You can find me at Dr. Shannon Decker.
Kelly: Thank you so much for providing that. And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…
[music] This concludes today’s episode of The Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.com/podcasts. The Hospital Finance Podcast is a production of BESLER | SMART ABOUT REVENUE, TENACIOUS ABOUT RESULTS.
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