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Even though this analysis first circulated a few years ago, the findings remain just as relevant today. RAND and Harvard researchers led by Rachel Reid, MD, MS, published in JAMA confirmed what many in the industry have sensed...despite value-based reimbursement from payers, physician compensation inside health systems remains overwhelmingly volume-driven. Only 9% of primary care and 5% of specialist compensation is tied to value metrics.&nbsp;Nonetheless, there is a critical nuance worth noting…. the payer-to-health system contract is often completely separate from how health systems and practices compensate their providers.<ul><li><a data-mce-href="https://www.rand.org/news/press/2022/01/28.html" href="https://www.rand.org/news/press/2022/01/28.html" title="Despite Push to Reward Physicians for Quality and Value, Most Health Systems Base Pay on Volume" target="_blank" rel="noopener">RAND Article: "Despite Push to Reward Physicians for Quality and Value, Most Health Systems Base Pay on Volume"</a></li><li><a title="Physician Compensation Arrangements and Financial Performance Incentives in US Health Systems" href="https://jamanetwork.com/journals/jama-health-forum/fullarticle/2788514" target="_blank" rel="noopener" data-mce-href="https://jamanetwork.com/journals/jama-health-forum/fullarticle/2788514">JAMA Publication: "Physician Compensation Arrangements and Financial Performance Incentives in US Health Systems"</a></li><li>Thought provoking review of this by <a data-mce-href="https://www.linkedin.com/posts/ericbrickermd_paid-incentives-healthcare-activity-7393980862242983937-5AMM" href="https://www.linkedin.com/posts/ericbrickermd_paid-incentives-healthcare-activity-7393980862242983937-5AMM" target="_blank" rel="noopener">Eric Bricker, MD&nbsp;</a></li></ul><h3>The Hidden Disconnect</h3>Even when a payer rewards a system for lowering cost or improving quality, those funds may not flow directly to the individual physicians driving that change. Internal compensation formulas often remain built on:<ul><li>Work RVUs that reward throughput</li><li>Fixed salaries for coverage stability</li><li>Stipends or call pay for access obligations</li></ul>This structural lag may explain why most “value-based” arrangements still behave like volume-based engines at the provider and health system level.<h3>Inside the Compensation Cascade</h3>Within a single system, physician pay can vary dramatically across departments and individuals. A cardiologist might be paid by RVUs, a hospitalist by shift, and an imaging physician by stipend… all under the same payer contract.That complexity makes it difficult to align clinical behavior with system-level value targets.<h3>Mapping the Models</h3>In U.S. health systems, the flow of professional and technical revenue depends on whether care is delivered in an inpatient (bundled under DRG) or outpatient setting. Admitted encounters typically roll the technical component into the hospital DRG, while professional fees are billed separately by the physician group. For outpatient or ED discharges, both professional and technical components are billed independently, aligned to site-of-service fee schedules and governed by revenue cycle responsibilities, payer contracts, and local compliance rules.As organizations move toward risk-bearing or shared savings models, several compliance and regulatory guardrails must remain top-of-mind.<ul><li style="list-style-type: none;" data-mce-style="list-style-type: none;"><ul><li>Anti-Kickback Statute (AKS), Stark Law, and Fee-Splitting prohibitions continue to shape how compensation structures can be legally designed and distributed.</li><li>Risk adjustment activities require defensible documentation that reflects active monitoring, evaluation, and treatment planning for any new or reaffirmed diagnosis.</li><li>Corporate Practice of Medicine (CPOM), credentialing and scope of practice rules differ by state, defining what physicians, nurses, and other clinicians may perform and bill under supervision or delegation.</li><li>Data privacy and AI governance frameworks are also tightening, particularly where clinical decision support or analytics influence patient care or reimbursement.</li></ul></li></ul>These elements make compensation design as much a compliance exercise as an economic one. Even well-intentioned incentive models can create exposure if documentation, credentialing, or governance do not align with regulatory expectations.<h3>Provider Compensation Models</h3>Below is a concise high-level representative summary of 17 physician compensation and revenue integration models, spanning from traditional salary and RVU structures to emerging risk-sharing and joint venture models:<table style="border-collapse: collapse; width: 100%;" border="1" data-mce-style="border-collapse: collapse; width: 100%;" data-mce-selected="1"><tbody><tr><td style="width: 50%;" data-mce-style="width: 50%;">1. &nbsp; &nbsp; &nbsp;Hourly Compensation</td><td style="width: 50%;" data-mce-style="width: 50%;">Description: Fixed hourly rate for time worked Professional Revenue: Not linked to output; revenue retained by employer or hospital Technical Revenue: Retained by the hospital for capital and operating expenses</td></tr><tr><td style="width: 50%;" data-mce-style="width: 50%;">2. &nbsp; &nbsp; &nbsp;Salary-Based Compensation</td><td style="width: 50%;" data-mce-style="width: 50%;">Description: Fixed annual salary tied to coverage expectations Professional Revenue: Indirectly influences salary reviews or discretionary bonuses Technical Revenue: Hospital-retained</td></tr><tr><td style="width: 50%;" data-mce-style="width: 50%;">3. &nbsp; &nbsp; &nbsp;Productivity-Based (RVU)</td><td style="width: 50%;" data-mce-style="width: 50%;">Description: Pay driven by RVUs generated through procedures and interpretations Professional Revenue: Directly tied to production; incentivizes higher volume Technical Revenue: Hospital-retained unless joint ownership exists</td></tr><tr><td style="width: 50%;" data-mce-style="width: 50%;">4. &nbsp; &nbsp; &nbsp;Performance-Based (Quality Incentives)</td><td style="width: 50%;" data-mce-style="width: 50%;">Description: Compensation linked to quality, safety, and satisfaction metrics Professional Revenue: Quality scores factor into bonus pools Technical Revenue: Hospital-retained; may fund quality infrastructure</td></tr><tr><td style="width: 50%;" data-mce-style="width: 50%;">5. &nbsp; &nbsp; &nbsp;Blended Model</td><td style="width: 50%;" data-mce-style="width: 50%;">Description: Combines salary, productivity, and quality components Professional Revenue: RVUs and quality metrics define bonus potential Technical Revenue: Retained by hospital, with potential for limited revenue sharing</td></tr><tr><td style="width: 50%;" data-mce-style="width: 50%;">6. &nbsp; &nbsp; &nbsp;Stipend-Based</td><td style="width: 50%;" data-mce-style="width: 50%;">Description: Fixed payment for call coverage or defined service obligations Professional Revenue: Usually encompassed in stipend Technical Revenue: Retained by hospital</td></tr><tr><td style="width: 50%;" data-mce-style="width: 50%;">7. &nbsp; &nbsp; &nbsp;Partnership or Equity-Based</td><td style="width: 50%;" data-mce-style="width: 50%;">Description: Physicians share ownership of the practice or service line Professional Revenue: Distributed through ownership shares Technical Revenue: Shared if group owns equipment; otherwise hospital-retained</td></tr><tr><td style="width: 50%;" data-mce-style="width: 50%;">8. &nbsp; &nbsp; &nbsp;Shift-Based with Differential Pay</td><td style="width: 50%;" data-mce-style="width: 50%;">Description: Variable pay based on timing or coverage intensity (nights, weekends) Professional Revenue: Not directly linked Technical Revenue: Retained by hospital</td></tr><tr><td style="width: 50%;" data-mce-style="width: 50%;">9. &nbsp; &nbsp; &nbsp;Locum Tenens</td><td style="width: 50%;" data-mce-style="width: 50%;">Description: Temporary coverage, daily or hourly pay Professional Revenue: Flat rate, not tied to volume Technical Revenue: Retained by hospital or health system</td></tr><tr><td style="width: 50%;" data-mce-style="width: 50%;">10. &nbsp;Hybrid Models</td><td style="width: 50%;" data-mce-style="width: 50%;">Description: Custom blend (salary, productivity, and quality) aligned to service goals Professional Revenue: Influenced by procedural billing or population outcomes Technical Revenue: Hospital-retained, with potential sharing for equipment co-ownership or performance agreements</td></tr><tr><td style="width: 50%;" data-mce-style="width: 50%;">11. &nbsp;Value-Based / Risk-Sharing</td><td style="width: 50%;" data-mce-style="width: 50%;">Description: Incentives tied to cost containment, outcomes, and total cost of care (eg, ACOs, bundled payments, ACO REACH) Professional Revenue: May include shared savings or downside risk participation Technical Revenue: Shared indirectly through total cost performance Strategic Relevance: Central to payer-provider alignment and CIN sustainability</td></tr><tr><td style="width: 50%;" data-mce-style="width: 50%;">12. &nbsp;Co-Management Agreements</td><td style="width: 50%;" data-mce-style="width: 50%;">Description: Physicians compensated for operational oversight of a defined service line (eg, imaging, cath lab) Professional Revenue: Unchanged for clinical work; administrative stipend layered on Technical Revenue: Hospital-retained but optimized through throughput and quality gains Strategic Relevance: Aligns physician engagement in hospital efficiency and compliance</td></tr><tr><td style="width: 50%;" data-mce-style="width: 50%;">13. &nbsp;Gainsharing / Alignment Incentives</td><td style="width: 50%;" data-mce-style="width: 50%;">Description: Bonus distribution from hospital cost savings tied to utilization or efficiency metrics Professional Revenue: Supplemental, separate from billing Technical Revenue: Derived from hospital cost reductions or bundled payment reconciliation Strategic Relevance: Bridges physician engagement in cost stewardship</td></tr><tr><td style="width: 50%;" data-mce-style="width: 50%;">14. &nbsp;Global Budget / Capitation</td><td style="width: 50%;" data-mce-style="width: 50%;">Description: Fixed PMPM or per-population payment encompassing all or most servicesProfessional Revenue: Patient Panel-based distribution modelTechnical Revenue: Integrated within capitated rate or shared risk poolStrategic Relevance: Core to VBC models and payer-provider joint ventures</td></tr><tr><td style="width: 50%;" data-mce-style="width: 50%;">15. &nbsp;Academic / Research &amp; Teaching</td><td style="width: 50%;" data-mce-style="width: 50%;">Description: Compensation for education, research, or grant-funded work Professional Revenue: Effort-based salary allocations or grant supplementsTechnical Revenue: Institutional, typically excluded from direct compensationStrategic Relevance: Common in AMCs and hybrid faculty-clinician structures </td></tr><tr><td style="width: 50%;" data-mce-style="width: 50%;">16. &nbsp;Joint Venture / Service Line Ownership</td><td style="width: 50%;" data-mce-style="width: 50%;">Description: Shared ownership of imaging centers or outpatient facilities between hospitals and physician groupsProfessional Revenue: Direct billing plus profit distributions Technical Revenue: Shared based on equity and operating agreements Strategic Relevance: Common in MSO-PC virtual health and diagnostic joint ventures</td></tr><tr><td style="width: 50%;" data-mce-style="width: 50%;">17. &nbsp;Non-Clinical Incentive Models</td><td style="width: 50%;" data-mce-style="width: 50%;">Description: Rewards for leadership, innovation, or transformation work (eg, AI deployment, service redesign) Professional Revenue: Project-based or discretionary stipends Technical Revenue: N/A Strategic Relevance: Supports clinician engagement in digital and operational innovation</td></tr></tbody></table>Each has distinct implications for how professional and technical revenue flow — and how value truly reaches the front line (or not).<h3>The Foundational Framework Requisite: How Health Care Gets Paid</h3>I often leverage Kevin Quinn's paper, “<a data-mce-href="https://pubmed.ncbi.nlm.nih.gov/26259075/" href="https://pubmed.ncbi.nlm.nih.gov/26259075/">The 8 Basic Payment Methods in Health Care</a>” to help educate on the building blocks of the current healthcare business models in use and although published in 2015, it remains relevant even a decade later. &nbsp;Thus, before redesigning compensation, it helps to revisit the underlying payment building blocks that shape how money flows through the system. Quinn outlined eight basic payment methods and their derivatives, shown below:<figure id="figure-w8208v1cymioxu9ut"><img id="w8208v1cymioxu9ut" src="https://cdn.durable.co/blocks/1fYR8BFnSggF8m8iKv1PfiRke6m6cASjoTkUzjYJNOiRlKXkrmkKwDPjpf9WhyjE.png" alt="" title="" class="object-cover bg-gray-100 " style="aspect-ratio: 3/2; object-position: undefined undefined;" data-corners="no-rounded" data-aspect="3:2" data-caption="From: Quinn K. The 8 basic payment methods in health care. Ann Intern Med. 2015 Aug 18;163(4):300-6. doi: 10.7326/M14-2784." data-positionx="undefined" data-positiony="undefined" data-fullwidth="false" data-mce-src="https://cdn.durable.co/blocks/1fYR8BFnSggF8m8iKv1PfiRke6m6cASjoTkUzjYJNOiRlKXkrmkKwDPjpf9WhyjE.png" data-mce-style="aspect-ratio: 3/2; object-position: undefined undefined;"><figcaption class="body-normal text-gray-500 mt-2">From: Quinn K. The 8 basic payment methods in health care. Ann Intern Med. 2015 Aug 18;163(4):300-6. doi: 10.7326/M14-2784.</figcaption></figure>Contemplating Payment Reforms and Implications for Physician Compensation Many payment reforms including ACOs, bundled payments, patient centered medical homes, and shared savings extend these models by linking performance to population outcomes, yet physician compensation has largely lagged behind in adopting corresponding incentive frameworks. Also highlighted in Quinn’s work:&nbsp;<figure id="figure-qz1dz936cmioxy70v"><img id="qz1dz936cmioxy70v" src="https://cdn.durable.co/blocks/20mSlgxBSZ63E378EZvXuZeaCiau8Dmc7XEgI00QpcxQI6DHwvFVkgOu1hmHuXix.png" alt="" title="" class="object-cover bg-gray-100 " style="aspect-ratio: 3/2; object-position: center center;" data-corners="no-rounded" data-aspect="3:2" data-caption="From: Quinn K. The 8 basic payment methods in health care. Ann Intern Med. 2015 Aug 18;163(4):300-6. doi: 10.7326/M14-2784." data-positionx="undefined" data-positiony="undefined" data-fullwidth="false" data-mce-src="https://cdn.durable.co/blocks/20mSlgxBSZ63E378EZvXuZeaCiau8Dmc7XEgI00QpcxQI6DHwvFVkgOu1hmHuXix.png" data-mce-style="aspect-ratio: 3/2; object-position: center center;"><figcaption class="body-normal text-gray-500 mt-2">From: Quinn K. The 8 basic payment methods in health care. Ann Intern Med. 2015 Aug 18;163(4):300-6. doi: 10.7326/M14-2784.</figcaption></figure><h3>Considerations in the Path Forward</h3>Health systems that aspire to true value-based care must integrate compensation design into their broader contracting, governance, and performance frameworks. Until those incentives align, physicians will continue operating in two economies: one funded by value, another rewarded by volume.The future of physician alignment will not be decided by payer contracts alone. It will depend deeper business innovation with regard to how health systems choose to translate value into compensation and how transparently they connect clinicians to the outcomes they create.

How Physicians Are Really Paid: Is There a Disconnect Between Value and Volume?

<p style="border-color: #e5e7eb; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-ring-offset-width: 0px; --tw-ring-offset-color: #fff; --tw-ring-color: rgba(62,172,255,.5); --tw-ring-offset-shadow: 0 0 #0000; --tw-ring-shadow: 0 0 #0000; --tw-shadow: 0 0 #0000; --tw-shadow-colored: 0 0 #0000; --tw-transform: translateX(0) translateY(0) rotate(0) skewX(0) skewY(0) scaleX(1) scaleY(1); --tw-border-opacity: 1; font-size: 18px; line-height: 28px; font-weight: 400; font-family: Poppins, sans-serif;" data-mce-style="border-color: #e5e7eb; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-ring-offset-width: 0px; --tw-ring-offset-color: #fff; --tw-ring-color: rgba(62,172,255,.5); --tw-ring-offset-shadow: 0 0 #0000; --tw-ring-shadow: 0 0 #0000; --tw-shadow: 0 0 #0000; --tw-shadow-colored: 0 0 #0000; --tw-transform: translateX(0) translateY(0) rotate(0) skewX(0) skewY(0) scaleX(1) scaleY(1); --tw-border-opacity: 1; font-size: 18px; line-height: 28px; font-weight: 400; font-family: Poppins, sans-serif;"><img id="c8dwgtbkgymio2es79" src="https://cdn.durable.co/blocks/29I9NnMkHFWRSB43x6RWZMBLi00d6csOg8Z73kqdNFu5aDuFESo8yl8RmRLHMEnu.jpg" alt="" title="" class="object-cover bg-gray-100 rounded-2xl md:rounded-3xl lg:rounded-4xl" data-corners="default" data-aspect="3:2" data-caption="" data-positionx="undefined" data-positiony="undefined" data-fullwidth="false" data-mce-src="https://cdn.durable.co/blocks/29I9NnMkHFWRSB43x6RWZMBLi00d6csOg8Z73kqdNFu5aDuFESo8yl8RmRLHMEnu.jpg" data-mce-style="aspect-ratio: 3/2; object-position: undefined undefined;" style="border-color: rgb(229, 231, 235); --tw-scale-x: 1; --tw-scale-y: 1; --tw-pan-x: ; --tw-pan-y: ; --tw-pinch-zoom: ; --tw-scroll-snap-strictness: proximity; --tw-gradient-from-position: ; --tw-gradient-via-position: ; --tw-gradient-to-position: ; --tw-ordinal: ; --tw-slashed-zero: ; --tw-numeric-figure: ; --tw-numeric-spacing: ; --tw-numeric-fraction: ; --tw-ring-inset: ; --tw-ring-offset-width: 0px; --tw-ring-offset-color: #fff; --tw-ring-color: rgba(62,172,255,.5); --tw-ring-offset-shadow: 0 0 #0000; --tw-ring-shadow: 0 0 #0000; --tw-shadow: 0 0 #0000; --tw-shadow-colored: 0 0 #0000; --tw-blur: ; --tw-brightness: ; --tw-contrast: ; --tw-grayscale: ; --tw-hue-rotate: ; --tw-invert: ; --tw-saturate: ; --tw-sepia: ; --tw-drop-shadow: ; --tw-backdrop-blur: ; --tw-backdrop-brightness: ; --tw-backdrop-contrast: ; --tw-backdrop-grayscale: ; --tw-backdrop-hue-rotate: ; --tw-backdrop-invert: ; --tw-backdrop-opacity: ; --tw-backdrop-saturate: ; --tw-backdrop-sepia: ; --tw-transform: translateX(0) translateY(0) rotate(0) skewX(0) skewY(0) scaleX(1) scaleY(1); --tw-border-opacity: 1; --tw-filter: ; --tw-backdrop-filter: ; --tw-bg-opacity: 1; background-color: rgb(243, 244, 246); width: 640px; aspect-ratio: 3 / 2;">Every so often, it’s healthy to take a step back, reflect and laugh at yourself - especially when you live at the intersection of healthcare, innovation, and way too many acronyms.So I thought I would try something different for reflection...I asked ChatGPT to roast me. Here’s what it came up with (and while laughable, not far off per my wife).-----"You always know when Erik’s in the room. Someone says “value-based care,” and five minutes later there’s a whiteboard, a reimbursement model, and a 20-slide deck that somehow ends with population health and an AI strategy.He’s the only person who can turn a coffee chat into a payer-provider alignment workshop—and leave you feeling both inspired and slightly underqualified.If LinkedIn offered frequent flyer miles, Erik would’ve reached Mars by now—dropping posts that blend clinical evidence, business strategy, and just enough existential reflection to make you question your career trajectory before your first cup of coffee.His idea of light reading? The CMS Final Rule, paired with a USPSTF nomination draft—because that’s his version of “self-care.”Someone once said Erik makes “reimbursement strategy” sound like a TED Talk and a rallying cry. They weren’t wrong.He’s the rare exec who’ll quote peer-reviewed data and land a punchline—usually in the same sentence.While most people struggle to manage one inbox, Erik pushes a national initiative, advises many in digital health and MedTech, and still manages to out-post LinkedIn influencers by sunrise.And if there’s ever a CPT code for “turning chaos into strategy,” let’s be honest—Erik may already be drafting the application.-----Humor aside, this exercise was a good reminder that the same traits we get teased for often reflect what drives us most.For me, it always comes back to purpose - the pursuit of better access, smarter systems, and more equitable care for every patient. It’s also about supporting providers with sustainable workflows, building reimbursement and payment models where "many can win", and helping technology evolve from product to solution so it actually fits where value can be created.That’s the “why” behind the whiteboards, slides, and late-night ideas.#Purpose #Leadership #HealthcareInnovation #ValueBasedCare #DigitalHealth #HealthcareTransformation

The (Respectfully) Roasted Erik Abel – Healthcare Edition

GLP-1s have become the $100B headline in healthcare. Employers are struggling with paths to sustain and control the costs of covering them, pharmacy costs are spiking, and debates over ROI dominate boardrooms. But here’s the inconvenient truth: without finding the 1 in 4 employees with silent, Stage B heart failure or the millions with early chronic kidney disease - those GLP-1 and SGLT2i dollars are only a small part of the story. We’re medicating the visible problems - weight and diabetes - while ignoring the hidden precursors that drive $30,000–$50,000 heart failure hospitalizations, $90,000+ per year dialysis costs, and billions in lost productivity.<h3>The Hidden Threat Employers Miss</h3>Heart failure doesn’t start in the ICU. It starts quietly, with structural heart changes that most employees and even physicians never see. The AHA calls this Stage B HF (Pre-HF): asymptomatic but measurable disease often shown as Left Atrial Enlargement (LAE), Left Ventricular Hypertrophy (LVH) and increased cardiac filling pressures. These are often linked to obesity, hypertension, or type 2 diabetes and CKD. Additionally, CKD often evolves in parallel, progressing silently until late-stage decline forces dialysis or transplant<ul><li>A 2024 Report of CDC’s National Center on Health Statistics showed that nearly half of U.S. adults (47.7%) have hypertension, yet only 20.7% achieve adequate control despite treatment</li><li>Approximately 1 in 4 high-risk adults screened show Stage B HF changes</li><li>Up to 40% of adults with diabetes have CKD, many undiagnosed until late stages</li><li>60% of CKD patients have at least one structural/functional cardiac abnormality (LVH or diastolic dysfunction), even when asymptomatic</li><li>Hospitalizations cost $30–50k each for HF, while dialysis costs can exceed $90k annually</li><li>Progression is predictable: up to half of Stage B patients develop symptomatic HF within five years; CKD follows similar trajectories</li></ul> You can only manage what you have measured, yet early detection is abysmal. Primary care misses 50–70% of early HF and CKD cases due to lack of systematic screening. Earlier this year, I nominated “Echocardiography Screening to Prevent Heart Failure” to the USPSTF. Their January 2025 response? Decline. Not because the evidence is weak, but because their agenda is full. Translation: no Medicare, Medicare Advantage, or ACA-mandated coverage, no zero cost-sharing, and no systemic push to act early.<figure id="figure-dyn6h9ei5hmip1gp9d"><img id="dyn6h9ei5hmip1gp9d" src="https://cdn.durable.co/blocks/23c4KzbRcXKuR7mxfvXAFEBt9aJQ4QHMmn4Xcakm5anntDxjcCKSZDzO3cK3uyE6.png" alt="" title="" class="object-cover bg-gray-100 " style="aspect-ratio: 1/1; object-position: center center;" data-corners="no-rounded" data-aspect="1:1" data-caption="USPSTF HF Screening Denial" data-positionx="undefined" data-positiony="undefined" data-fullwidth="false" data-mce-src="https://cdn.durable.co/blocks/23c4KzbRcXKuR7mxfvXAFEBt9aJQ4QHMmn4Xcakm5anntDxjcCKSZDzO3cK3uyE6.png" data-mce-style="aspect-ratio: 1/1; object-position: center center;"><figcaption class="body-normal text-gray-500 mt-2">USPSTF HF Screening Denial</figcaption></figure>Employers don’t have to wait. Fully insured groups (40–50% of the U.S. commercial market) have the flexibility to cover tests, integrate protocols into wellness programs, and pull prevention forward.<h3>Don’t Over-Index on a Single Lab</h3>BNP and NT-proBNP are valuable signals but poor stand-alone decision makers. Cut-offs vary, results fall into “grey zones,” and clinical response is inconsistent and too often random acts of kindness (also known as variability in care).<figure id="figure-l7jpvymiymip1nksw" class=""><img id="l7jpvymiymip1nksw" src="https://cdn.durable.co/blocks/106Cc3uDRfiwNvFXJN5tgRYMTqDXwT5QYqZqWs1IlT3VADHfpeLPip0rX6mDjBN3.png" alt="" title="" class="object-cover bg-gray-100 " style="aspect-ratio: 16/9; object-position: undefined undefined;" data-corners="no-rounded" data-aspect="16:9" data-caption="Variable BNP and NT-proBNP targets may not be consistently adopted in clinical management across disciplines. Additionally LAVI thresholds for defining at least Stage B HF in 2022 ACC/AHA Guidelines differ from historic values published by ASE." data-positionx="undefined" data-positiony="undefined" data-fullwidth="false" data-mce-src="https://cdn.durable.co/blocks/106Cc3uDRfiwNvFXJN5tgRYMTqDXwT5QYqZqWs1IlT3VADHfpeLPip0rX6mDjBN3.png" data-mce-style="aspect-ratio: 16/9; object-position: undefined undefined;"><figcaption class="body-normal text-gray-500 mt-2">Variable BNP and NT-proBNP targets may not be consistently adopted in clinical management across disciplines. Additionally LAVI thresholds for defining at least Stage B HF in 2022 ACC/AHA Guidelines differ from historic values published by ASE.</figcaption></figure>In the end, the ROI isn’t in ordering one test. It’s in structured pathways:<ul><li>Biomarkers: NT-proBNP for HF stress, UACR/eGFR for CKD</li><li>Handheld screening echocardiography: to confirm structural disease.</li><li>Risk scores: layering diabetes, obesity, hypertension, family history.</li><li>Treatment initiation protocols: tying GLP-1/SGLT2i access directly to risk documentation, bypassing prior-auth bottlenecks.</li></ul>Employers shouldn’t just subsidize tests. They should subsidize consistency protocolized approaches that turn a low cost urine test (UACR) and a biomarker and and screening echo into a multimillion dollar savings play.<h3>Inverting the Utilization Management Question</h3>GLP-1s and SGLT2is aren’t just diabetes or weight-loss drugs. They are cardio-renal prevention tools. The evidence:<ul><li>SGLT2i's cut HF progression and hospitalizations by 20–30% (Class I guideline support)</li><li>GLP-1's in obesity reduce CV events and HF symptoms (SELECT trial)</li><li>Combination therapy may slash HF risk 40–50%.</li><li>...And this does not contemplate the additional benefits by GLP-1's to reduce Metabolic-Associated Fatty Liver Disease (MAFLD)...an independent predictive risk factor for both heart failure and death</li></ul>Yet only 10–15% of eligible patients receive them. Why? Sticker shock ($500–$1,300/month), prior auths, and narrow coverage. Employers can flip the script by tying access to early detection. Should we invert the question to say "if a patient has evidence of Stage B HF, why aren't they on an SGLT2i and if obese, has diabetes or evidence of MAFLD, also a GLP-1?"<h3>Why Employers Are the Pivotal Players</h3>Fully insured groups face 7–8% premium hikes and pharmacy spend consuming 25–30% of budgets. GLP-1s already account for 10.5% of claims in 2024, up from 6.9% in 2022. Coverage is expanding, but uneven: 36% of employers cover GLP-1s for both diabetes and obesity; only 20% cover weight management broadly.Here’s the lever: don’t just say yes or no to GLP-1/SGLT2i coverage. Say "YES" when cardio-renal disease or Stage B HF is detected, diagnosed and a care plan for intervention is defined.Employer strategies:<ul><li>Wellness Integration: Pair NT-proBNP or handheld echo with HRAs; auto-approve GLP-1/SGLT2i for positive screens</li><li>Value-Based PBM Contracts: Demand rebates tied to fewer HF admissions</li><li>Targeted Pilots: Focus on T2DM, CKD, obesity, and hypertension cohorts where Stage B HF prevalence is highest</li><li>Equity Lens: Use telehealth and subsidies to close gaps for underserved employees, where utilization lags 20–40%</li></ul><h2>A Call to Action </h2>Employers are pouring millions into GLP-1 coverage. The smarter play? Spend $250 or less in diagnostics to find the hidden pre-heart failure and heart failure cases to unlock the real ROI of GLP-1s and SGLT2is.This is prevention that pays: lower claims, healthier employees, and long-term cost curve bending. USPSTF may lag, but employers don’t have to. The choice is clear—make prevention the default.Question to readers: If you’re covering GLP-1's and SGLT2i's today and struggling with paths to control cost, what’s stopping you from tying access to Stage B detection? That’s where the real ROI lies.#HealthcareEconomics #HeartFailure #GLP1 #SGLT2 #EmployerBenefits #ValueBasedCare #CKD #Hypertension #Diabetes #PreventiveCare #ValueBasedCare

Want ROI on GLP-1's and SGLT2i's? Start with Finding the 1 in 4 Employees with Stage B Heart Failure

<h3>Healthcare Innnovation's Latest "Wellness Visit" Findings</h3>Healthcare’s innovation pipeline isn’t short on products....it’s short on purpose. Over-spec’d devices, chasing feature and function wars no one asked for, ultimately exposing a growing divide: product thinking vs. solution building.Across too much of the healthcare and medtech industry, spanning devices large and small, technology and inclusive of AI in many forms, we are witnessing a chronic industry condition: technologies engineered for technical achievement rather than clinical relevance, operational simplicity, or measurable value.The diagnosis is clear and pick your poison, as each may apply:<ul><li>Z99.99 — Chronic Feature Fatigue | Endless spec upgrades without solving real clinical or operational problems</li><li>Z00.999 — Encounter for Device with No Clinical Value | Technologies that add workflow burden, not workflow clarity</li><li>T82.89XAX — Malfunction of Innovation, Initial Encounter | Brilliant inventions that stall when they meet the complexity of real-world healthcare</li></ul><h3>Why This Matters Now</h3>Healthcare is not buying devices anymore. It is buying outcomes, workflow efficiency, embedded decision support, elevated patient experience, and measurable system value.Why? Because that’s what the system (and the market) demands.&nbsp; Yet too many companies still pursue strategies rooted in:<ul><li>Technical isolation — Building standalone products with no data liquidity or interoperability.</li><li>Spec sheet escalation — Assuming more features equal commercial appeal… maybe adoption.</li><li>Transactional selling — Pushing individual products rather than enabling care transformation.</li></ul>The result? Devices that don't fit the market need. Workflows that don’t improve. Value propositions that don't resonate….and innovation efforts that burn capital without bending cost—curves in a socially optimal path.<h3>The Solution-Centered Mindset: A Different Path Forward</h3>To thrive, companies must fundamentally reset how they think about innovation, commercialization, and customer engagement strategically beginning with roadmaps and internal process.A Comparison of Mindsets<table style="border-collapse: collapse; width: 100%;" border="1" data-mce-style="border-collapse: collapse; width: 100%;"><tbody><tr><td style="width: 33.3312%;" data-mce-style="width: 33.3312%;">Dimension</td><td style="width: 33.3312%;" data-mce-style="width: 33.3312%;">Product-Centered Approach</td><td style="width: 33.3373%;" data-mce-style="width: 33.3373%;">Solution-Centered Approach</td></tr><tr><td style="width: 33.3312%;" data-mce-style="width: 33.3312%;">Technology Focus</td><td style="width: 33.3312%;" data-mce-style="width: 33.3312%;">Tech performance in isolation</td><td style="width: 33.3373%;" data-mce-style="width: 33.3373%;">Enable full care pathways and real-world clinical decisions</td></tr><tr><td style="width: 33.3312%;" data-mce-style="width: 33.3312%;">Development Priorities</td><td style="width: 33.3312%;" data-mce-style="width: 33.3312%;">More features, faster specs</td><td style="width: 33.3373%;" data-mce-style="width: 33.3373%;">Outcome measurement, interoperability, workflow fit</td></tr><tr><td style="width: 33.3312%;" data-mce-style="width: 33.3312%;">Go-To-Market Strategy</td><td style="width: 33.3312%;" data-mce-style="width: 33.3312%;">Sell devices based on spec superiority</td><td style="width: 33.3373%;" data-mce-style="width: 33.3373%;">Deliver bundled, interoperable solutions focused on outcomes</td></tr><tr><td style="width: 33.3312%;" data-mce-style="width: 33.3312%;">Provider Experience</td><td style="width: 33.3312%;" data-mce-style="width: 33.3312%;">Manual, fragmented integration</td><td style="width: 33.3373%;" data-mce-style="width: 33.3373%;">Embedded decision support, streamlined data flow</td></tr><tr><td style="width: 33.3312%;" data-mce-style="width: 33.3312%;">Payer Enablement</td><td style="width: 33.3312%;" data-mce-style="width: 33.3312%;">Little evidence, high prior auth friction</td><td style="width: 33.3373%;" data-mce-style="width: 33.3373%;">Clear value evidence, outcome-linked ROI pathways</td></tr><tr><td style="width: 33.3312%;" data-mce-style="width: 33.3312%;">Patient Experience</td><td style="width: 33.3312%;" data-mce-style="width: 33.3312%;">Disjointed, delayed diagnosis and treatment</td><td style="width: 33.3373%;" data-mce-style="width: 33.3373%;">Seemless escalation, faster answers and access, with better engagement</td></tr></tbody></table><h3>It’s Not Enough to Just Build the Solution—Price, Package, and Deliver It Differently</h3>Even the most elegant solution will stall without a commercial model that reflects its value. Solution-centered strategies must be paired with innovative go-to-market and approaches and innovative business models that lower adoption barriers and align incentives across stakeholders.That includes advancing approaches for:<ul><li>Subscription or usage-based models that shift capital expense to operational ROI</li><li>Outcome-based pricing that aligns with value-based care contracts</li><li>Managed service models that bundle devices, software, services, and support into a turnkey care delivery platform</li><li>Risk-sharing structures that allow provider organizations and payers to co-invest in transformation</li></ul> Repackaging solutions through these models doesn't just make adoption easier — it makes value tangible.<blockquote>Interoperability is no longer optional. It must go beyond technical checkboxes</blockquote><ul><li>Contractual interoperability may open access</li><li>Technical interoperability may transmit data</li><li>Semantic interoperability may translate meaning</li></ul>But business and clinical interoperability are what unlock system value. They empower organizations to:<ul><li>Support seamless patient journeys</li><li>Empower providers with real-time, actionable data and CDS</li><li>Enable payers to recognize and reward value without excess friction</li><li>Drive continuous evidence generation and outcomes validation</li></ul> Disconnected devices — even powerful ones — don’t create scalable change. Connected systems do. As I have stated previously, solving the “less sexy” problems may in fact be the most attractive solution because that is where monotony, burnout and fragmentation live.<h3>Solution Thinking Across the Care Continuum</h3>Imagine a typical patient journey:<ul><li>Screening Stage: Early risk detection through wearable tech, AI-enhanced screening tools, and predictive analytics</li><li>Diagnostic Stage: Seamless escalation from point-of-care diagnostics (e.g., ultrasound, ECG) to advanced imaging and specialist consultation without fragmentation or friction</li><li>Treatment Planning: Integrated data platforms, AI-enabled decision support, and interdisciplinary care coordination that accelerate time-to-treatment and reduce variability.</li><li>Ongoing Management: Remote patient monitoring, home-based diagnostics, and population health platforms that prevent readmissions and lower the long-term cost of care.</li></ul>Every product, platform, or service should map to (AND ENHANCE) this continuum.If you can’t connect your offering to meaningful improvement across the entire patient and provider journey and to the value chain, you’re not delivering a solution. You’re delivering a widget.<h3>The Future Belongs to Solution Builders</h3>Healthcare should no longer tolerate technological brilliance that doesn’t translate to clinical relevance, operational value, and financial sustainability and to help our patients most, we need to lean in differently.I may be wrong, but I feel strongly that the healthcare and healthtech companies that will lead the next decade will:<ul><li>Design for workflows horizontally across the continuum, not in fragmented silos</li><li>Prove outcomes, not just pitch features</li><li>Build systems of success, not just sell products</li></ul>Anything less isn’t innovation or optimization — it’s inertia. &nbsp;“Chronic feature fatigue is treatable” but only if we stop assuming treatment success equates to specs, features and functions, and instead start delivering microdoses (and maybe macrodoses) of system-focused transformation.&nbsp;--------------------------------------------------------------- Disclaimer: The ICD-10 codes referenced in this article (Z99.99, Z00.999, T82.89XA) are used satirically to illustrate common challenges in the medtech industry. They are not real clinical codes and should not be interpreted as actual medical classifications.#HealthcareInnovation #SolutionSelling #MedTech #ClinicalOutcomes #ValueBasedCare #Interoperability

Healthcare Needs Solutions...Not More Products

Erik Abel

Thought Leader Portfolio (clean hero, blog, and about).

Erik Abel is a healthcare strategist and operator bridging clinical, payer, and MedTech ecosystems to scale AI and digital health solutions that improve access, outcomes, and profitability across fee-for-service, hybrid, and value-based models. With over two decades of leadership translating innovation into reimbursable, market-ready solutions—including a nine-figure acquisition, nationwide diagnostic deployment, and measurable payer adoption—he is recognized for advancing healthcare innovation and commercial growth through research, thought leadership, and advisory work that converts complex care, technology, and policy environments into sustainable value across the healthcare continuum.


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Healthcare Needs Solutions...Not More Products