Smaller Panels and Limited Participation in VBC

NP panels tend to be smaller as NPs prioritize spending more time with each patient. While this enhances care quality and prevention, it limits the patient volume required to participate directly with insurers in value-based care (VBC) contracts. Additionally, Medicare attribution rules have historically undervalued NPs' contributions, assigning credit primarily to physicians. This exclusion from key performance-based programs has discouraged aggregators from targeting NP practices due to insufficient patient volume.

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Systemic Biases in Healthcare Hierarchy

Systemic biases in the healthcare hierarchy further marginalize NP-led practices. Traditional views often undervalue the role of NPs, overlooking their capacity to deliver cost-effective, high-quality care. This bias is compounded by their practice locations, which are often in underserved or shadowed communities that remain outside the radar of educational and outreach efforts promoting transformation needed for effective VBC participation. As a result, mastery of critical workflows like hierarchical condition category (HCC) coding and alignment with insurers’ cost-benefit metrics is less accessible to many NP-owned practices.

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Token Efforts from Insurer Programs

Current insurer programs aimed at involving NPs in VBC often fall short, offering limited incentives without addressing systemic barriers. These programs fail to fully recognize or reward the preventive care focus that is a hallmark of NP-led practices. This neglect undermines their potential contributions to reducing healthcare costs and improving outcomes on a larger scale.

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Uniting for Collective Impact

To overcome these challenges, nurse practitioners must band together to form networks or collaboratives. By pooling resources, gaining collective bargaining power, and amplifying their voices in policy and payer discussions, NPs can ensure that their exceptional contributions to prevention and care quality are adequately credited, valued, and rewarded within the evolving landscape of value-based care.

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