Do you know about VALUE-BASED CARE?

If you have insurance or Medicare, you should!

What is Value-Based Care?

Value-Based Care (VBC) is a health care delivery model under which providers are paid based on the health outcomes of their patients and the quality of services rendered. For some of our VBC contracts, Carolina Family Healthcare will share in financial risk with Medicare or the health insurance companies.

Sharing risk means that if our patients spend more than the annual allowed amount that Medicare or the insurance company allows, then we will have to repay all or a portion of the additional costs to the payer.

Total spend includes not only amounts paid to our office, but also to hospitals and emergency rooms, urgent care facilities, laboratories, radiology centers, diagnostic testing facilities, home health, home medical equipment, etc.

VBC also provides incentives to the primary care provider to provide high-quality, efficient care at a lower cost. VBC differs from the traditional fee-for-service model where providers are paid separately for each medical services.

While quality care can be provided under both models, it’s the difference in how providers are paid, paired with the way patient care is managed that provides the opportunity for health improvements and savings in a VBC environment.

Why do we need Value-Based Care?

The United States spends two to three times more than most developed countries each year, yet we achieve worse results. In addition, the disease burden in the U.S is the highest among developed countries.

Sixty percent (60%) of Americans have at least one chronic condition, such as high blood pressure, diabetes and mental illness, and forty percent (40%) of those are managing more than one chronic condition. A staggering ninety percent (90%) of health care dollars spent each year is for people with chronic health conditions.

In addition, an Institute of Medicine report found that waste, including unnecessary or repetitive tests, accounts for more than thirty percent (30%) of all health care expenditures. That’s more than $910 billion each year.

How can Value-Based Care help?

In the U.S., we’re used to a health care system that takes care of people after they’re already sick. VBC’s goal is to improve the health care experience, improve health of the individuals and populations and reduce costs of health care. To do this, VBC moves beyond sick care and adopts a proactive, team-oriented and data-driven approach to keeping people healthy.

At the center of VBC is a robust, team-oriented approach led by your primary care provider. Instead of having to navigate the health care system on your own, the care team is here to support you along your health care journey. At CFH, we will focus on prevention, wellness strategies and coordination through the care continuum with priority especially for those managing chronic conditions.

What can you as the patient do to help Carolina Family Healthcare and VBC?

There are many actions that you can do to help CFH achieve better outcomes and improve your health. First, you can schedule your annual preventive exam and have one performed each year. In addition, you can schedule all the preventive screenings your provider recommends for you, including a screening colonoscopy or mammogram. You can also sign up for our Chronic Care Management program and/or Remote Patient Monitoring program for monitoring blood pressure.

Most importantly, you should select Dr. Dino Kanelos or one of the other providers at CFH as your primary care provider with your insurance. For most insurers, you can select your PCP by logging onto their website, such as BCBSNC’s Blue Connect, or for Medicare Part B. Selecting your primary care provider will ensure that you are attributed to CFH, therefore we will get all your health care data which will help us to better manage your care.

If CFH or one of our providers is not your assigned PCP, then your data and any incentive payments for managing your care will go to another facility who doesn’t need access to your personal information.

If you need additional information on VBC, your insurance and how it will affect you, please email us at


As of January 2023, CFH participates with the following Value-Based Care Organizations and we intend to participate in some form of VBC with all major insurers by 2024.

  • Wellvana ACO REACH – Medicare Part B
  • Wellvana ACO – Humana Medicare Advantage
  • Aledade ACO of North Carolina – BCBSNC and Blue Medicare
  • Novant Health Clinically Integrated Network – Cigna