Increasingly twisting the meaning of Value in Value-based care
Pros
1. The mission of improving kidney care at home sounds admirable and can initially attract clinicians who value patient-centered, preventative medicine. 2. Patients are (mostly) genuinely appreciative of the care and follow-up, and many colleagues at the field level are compassionate, hard-working and supportive. 3. Remote structure offers flexibility and autonomy early on, though that has decreased over time.
Cons
1. Leadership culture has become increasingly toxic and retaliatory. Constructive feedback is often met with defensiveness, and clinicians who advocate for evidence-based practice or question unnecessary testing (e.g., excessive point-of-care A1Cs or spirometry) can face pressure to resign or be placed on “performance plans” that appear punitive rather than developmental. 2. Ethical conflicts are common: the company’s operational metrics often take precedence over clinical judgment, creating tension between what’s best for patients and what’s best for performance dashboards. 2. Communication and transparency are poor. Policies shift frequently, expectations are unclear, and frontline clinicians are left out of key decisions. 3. Retention is poor, morale is low, and turnover among NPs and care managers is high. 4. No true career growth opportunities — promotions and recognition appear to favor compliance over clinical skill or patient outcomes.