I practiced nephrology in eastern North Carolina for nearly 25 years. Like many of my colleagues, I went into medicine to give my patients the best care possible, helping them live longer, healthier lives.
But over time, the system began to chip away at my ability to fulfill that purpose. Growing administrative demands, declining reimbursement, the pressure to see more patients in a day, and a fragmented care delivery structure left little time for the kind of patient relationships and long-term impact that inspired many of us to enter the field.
That kind of longitudinal, patient-centered care simply isn’t supported by today’s dominant payment model. Most physicians practice in fee-for-service (FFS) environments that reward volume over value. The model is geared toward episodic care, incentivizing a high number of encounters rather than meaningful, continuous relationships. Reimbursements are tied to face-to-face visits, even though outcomes are often determined by what happens between them. And when a patient misses medications, struggles with transportation, or doesn’t understand their treatment plan, things can quickly unravel. Over time, even trust between the physician and patient becomes harder to build when the system rewards volume over relationships.
The FFS system isn’t built to intervene early. It’s built to react late. And it’s built to focus on a unique episode of care rather than the long-term outcome of that care.
A turning point in the pandemic
Early in the pandemic, amid a rising tide of burnout across the profession, my practice came to a crossroads. We gathered virtually one Saturday to talk honestly about what the future could look like. By the end of that eight-hour meeting, we made a bold decision: to go all-in on value-based care (VBC).
We knew it wouldn’t be easy. But we were drawn to the idea of re-centering care around what matters most — outcomes, not volume. We believed that by focusing on proactive, team-based support and restoring physicians as leaders in care, we could transform both the patient experience and the way we practiced medicine.
To do that, we had to change the culture of our practice. We appointed physician leads to oversee key areas of focus like end-stage kidney disease and chronic kidney disease (CKD) care pathways, transplantation, quality metrics, and clinical operations. We educated every member of the team — from front desk to clinical staff — on what VBC meant and how it would evolve their roles. The goal was shared ownership, shared accountability, and a shared vision for what better care could look like.
Building the infrastructure for better care
For practices transitioning to VBC, selecting the right partner is crucial to help manage risk and to access resources and purpose-built technologies that would be difficult to build internally. Additionally, these resources must be front loaded with hopeful returns two to three years later, and that’s difficult for a practice to fund when most of a practice’s revenue is still coming from FFS.
For us, one of the most meaningful changes was embedding renal care coordinators (RCCs) in our clinics—a role that we never could have afforded under the FFS model. These team members have become more than clinical staff. They are coaches, friends, and accountability partners who communicate frequently with patients between visits, help navigate barriers, and ensure care plans are followed through.
Alongside RCCs, dietitians, social workers, and advanced practice practitioners have also become essential members of the care team, helping patients overcome challenges that go far beyond what a physician can manage alone. Their presence has transformed not only outcomes but also the day-to-day experience of being a physician. We’re no longer trying to do everything alone; we are part of a team that is solely focused on achieving optimal outcomes for our patients.
Technology plays a role, too. With the adoption of a nephrology specific EHR, our practice could finally see the full picture of a patient’s journey, track quality measures, identify missed opportunities, and intervene earlier. Data became a tool for empowerment rather than a source of frustration.
Results that matter
In our first year participating in CMS’s Kidney Care Choices (KCC) model, our team achieved an 84% optimal start rate — a critical metric for improving patient outcomes — and earned one of only three perfect quality scores in the country.
But the impact went beyond the numbers. With the right resources in place to support patient management, we started to shift some of the administrative load off our shoulders. That freed us to focus more fully on what drew us to medicine in the first place — caring for patients. We had the time to listen, collaborate, and build trust and lasting relationships with our patients. For the physicians in our practice, regaining that time made an immeasurable difference.
From burnout to belief
In my decades of practicing in rural North Carolina, I cared for hundreds of patients and worked with dozens of clinicians and care team members. All of us could see glaring issues with the healthcare system that needed to be addressed, but system-level change is hard. Then, VBC gave us a new path forward. At a time when the system felt most broken, we chose to try something different. The leap wasn’t easy, but the results were undeniable.
With a team at our side, a model built to empower the patient through education and support, and a shared purpose guiding us, medicine became sustainable again. More than that, it became deeply fulfilling. One of my partners commented on how refreshing it was to see that the plan of care determined at the last patient visit had been fully executed because of the team’s fluid interaction with the patient between provider visits. “It made it so much easier for me to focus on what I needed to focus on.”
I have a new role now, but I’m not leaving medicine behind; I’m leaning in and hoping to help other practices make the same transformation we did. Because I believe VBC isn’t just the future of nephrology. It’s the path back to everything we love about being doctors.
We’re still early in this journey, yet we are seeing progress. Across the country, 14% of provider reimbursement is tied to VBC models, double what it was three years ago. And while VBC first emerged in primary care, it’s gaining a foothold in specialty care. My field of nephrology is one of the early adopters and a viewed as a model for other specialties to follow. If we can continue to prove this model works and start to scale the movement toward VBC, we can restore the autonomy, purpose, and joy that brought us
Photo credit: Ridofranz, Getty Images
Dr. Carney Taylor is Associate Chief Medical Officer at Interwell Health, bringing more than 20 years of clinical experience as a leading nephrologist to the role. He most recently served as the Co-President of Eastern Nephrology Associates in North Carolina. Dr. Taylor is a double-board certified physician in nephrology and internal medicine and holds a medical degree from East Carolina University School of Medicine, an MBA degree from East Carolina University, and a BA from the Virginia Military Institute. Dr. Taylor completed his residency and fellowship in nephrology at Vanderbilt University.
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