With our Advisory Board brain trust, we approached this question in three phases.

Phase 1: Influence mapping — Assessing industry power dynamics in VBC

Before we could analyze scenarios to nationwide risk, we needed to map out how much influence various stakeholders have on the outcome of VBC. How does (or could) each sector wield that influence? Who is most motivated to act? Who is at risk of being left out entirely?

We answer those questions in our VBC stakeholder infographic. This thinking laid the groundwork for how stakeholder dynamics would play out in a wide range of paths to nationwide risk.

Download the infographic

Phase 2: Divergence — Brainstorming paths to nationwide risk

Next, we wanted to envision as many paths as possible that could catalyze the industry toward broad adoption of risk. We convened a group of more than 25 researchers with a wide range of expertise and brainstormed the following question with them: What are paths to meaningful risk? Our open-ended discussion generated 24 discrete scenarios, some familiar and others more provocative.

View the scenarios

Phase 3: Convergence — Narrowing to paths worth exploring

With two dozen scenarios to play with, we began to filter down a few that we could explore in greater detail. We next asked the group of researchers two sets of questions based on the list above.

For the first set of questions, we told them to adopt a specific stakeholder’s lens, such as a life sciences company or health plan — whoever they work with most. We asked:

• If you could wave a magic wand, what one or two scenarios would you want to make happen?
• Which one or two scenarios would you want to prevent from happening?

Responses were highly variable. Predictably, stakeholders opposed paths that hurt their business and supported paths that advantaged them. This clearly demonstrates that not everyone wins in VBC, and the mix of winners and losers are different in each scenario. Across these scenarios, there are few winners — and a lot of losers.

For the second set of questions, we told the researchers to respond with their own perspective. We asked:

• Which scenario do you think would lead to the best quality and outcomes at the lowest cost?
• Which scenario do you think is the most likely?

There was more agreement on these questions. Most people thought paths 3, 5, 9, and 11 would lead to the best cost and quality outcomes. Interestingly, there was nearly a consensus around which path would be most likely. The top answer by far was path number 2: health plans purchase physician groups and clinics.

In this series, we dive into three scenarios–some approachable, others harder to imagine. We’ll start this series with the latter.

• Scenario 1: Employers pursue steerage and direct contracting with value-based providers.
• Scenario 2: Technology companies take their slice of healthcare, disrupting incumbents to reduce costs and make care delivery consumer-centric.
• Scenario 3: One national health plan takes its vertical integration strategy to the extreme, controlling where care happens and how it’s paid for.

For each one, we answer:

• How could the scenario unfold? How would it catalyze VBC?
• What would make it possible? What realities stand in the way?
• If this happens, what would the implications be for key industry stakeholders like physician groups, hospitals and health systems, and life sciences companies?

Part one of our series examines employers pursuing steerage and direct contracting with value-based providers.