Risant Health takes Kaiser Permanente's value-based care practices for a test drive — and likes the ride

Ralph Waldo Emerson, the 19th-century American philosopher and transcendentalist, wrote that “foolish consistency is the hobgoblin of little minds,” but Jaewon Ryu, M.D., J.D., believes that thoughtful consistency should be top of mind at U.S. hospitals and health systems.

“We know there is a lack of consistency around what happens to people when they land inside a hospital,” said Ryu, CEO of Risant Health. “We know, for example, that patients admitted to a hospital on a Tuesday have a very different experience than what happens with patients on Friday.”

Ryu is working to apply some of the lessons of consistency, “systemness” and value-based care best practices learned at Kaiser Permanente to Risant, with the goal of setting an example for other organizations to follow. Kaiser Permanente is a large, multistate integrated health system that has a health plan, hospitals and medical groups all under one roof and, as such, is something of an outlier in the complicated, accretive U.S. healthcare system. The Kaiser Foundation Hospitals formed Risant Health in 2023 to serve, in part, as a proving ground for applying some of Kaiser Permanente’s practices. Risant Health currently comprises Geisinger Health, a 10-hospital system in north central Pennsylvania that includes a medical school and a 550,000-member health plan, and Cone Health, a health system in North Carolina that comprises five hospitals and more than 100 medical groups.

Ryu and three of his colleagues at Risant and Geisinger described the progress Risant has made in scaling up various value-based practices in an article recently published in NEJM Catalyst, a digital offshoot of the New England Journal of Medicine that covers health systems. In the article, Ryu describes Risant as helping to scale Kaiser Permanente’s practices to more “pluralistic environments” than Kaiser, with “pluralistic” in this context meaning multiprovider and multipayer.

In an engaging and wide-ranging interview with Managed Healthcare Executive (MHE), Ryu highlighted shorter hospital stays and a “one-stop-shot resolution” of clinical issues as accomplishments of the adoption of Kaiser Permanente practices so far. According to the NEJM Catalyst article, the length of stay decreased by 0.14 days (from 5.29 to 5.15) from February 2025 to September 2025 at the Geisinger Community Medical Center in Scranton, Pennsylvania, where the central elements of the value-based practices were applied first.

Less time spent in the hospital “is a great barometer of quality,” Ryu said. “It is a great barometer of the patient experience, and it’s a great barometer of affordability … a leading indicator that suggests that we’re heading in the right direction.”

Ryu credited a digital “intelligent triage” tool with helping achieve the quick resolution of clinical issues. According to the NEJM Catalyst article, the tool uses a “dynamic series of questions,” along with information pulled from a patient’s electronic health record, to assess symptoms, generate a list of possible conditions and suggest the most appropriate place to receive care.

Ryu also mentioned a 5.2% reduction in referrals to specialists by primary care physicians, according to the NEJM Catalyst article, as an early indicator that value-based practices were having a positive effect. The value-based practice in this case was the use of value-based care guides for some 400 different conditions. That may seem like an unremarkable smidgen of a difference, “but if you extrapolate that over the thousands and thousands of specialty referrals that are generated every year, you’re opening up an awful lot of specialty appointments for others [who] have been waiting,” Ryu said. “If you look across this industry, the typical wait time for most specialties is greater than a month.”

Ryu and his NEJM Catalyst co-authors described the guides as succinct and noted that they are incorporated in the provider’s “native workflow” in the electronic health record. They also clearly define the role of the primary care physician and the specialist, they wrote, which creates “explicit accountability” about what care should be delivered by the primary care physician and what care should be delivered by the specialist.

Improved rounding

One simple, concrete change among many made at the Geisinger hospital was in rounding. Rounding happens at every hospital, Ryu said. “The physicians round. The nurses round. The clinical pharmacists round. The discharge planners round. But very rarely does that rounding happen altogether,” he said. All that rounding at different times by different kinds of healthcare specialists creates communication gaps. And, Ryu said, “if you’re the patient or the family, you’re left feeling pretty confused.” The hospital moved to a more consistent, integrated system of rounding.

Another change was communication and collaboration with the skilled nursing facilities to which some patients at Geisinger Community Medical Center are discharged. “Having a consistency on which places [to discharge to] and having a workflow and an ongoing communication with those skilled nursing facilities helps with handoffs of care,” Ryu said. According to the NEJM Catalyst article, the length of stay among patients discharged to skilled nursing facilities decreased by 0.91 days (from 9.16 to 8.25) without increasing the proportion of patients sent to skilled nursing facilities.

“Systemness” and priorities

Risant’s embrace of value-based care practice comes at a time when value-based care’s reputation has sagged. Experts debate how much it has accomplished over the past 15 or so years, since accountable care organizations began and CMS launched an armada of demonstration projects. Even its most enthusiastic proponents acknowledge that the promised land where U.S. healthcare financing and delivery are organized around value, not volume, shimmers somewhat distantly on the horizon.

As a guest on a Paragon Health Institute podcast in late January, Chris Klomp said value-based care is “something that’s been talked about for 20 years,” and that he was “fatigued” by the term. Klomp, who is now second in command at HHS under Secretary Robert F. Kennedy Jr., said one of the reasons value-based care has not been “particularly effective” is that Medicare has propagated a “system of centrally planned rate setting and policy setting.”

Defining terms can be a tedious, scholastic exercise, but it’s often necessary in U.S. healthcare, where the same term gets appropriated for different uses by different speakers. Ryu and his co-authors — Marc Mora, M.D., and Christopher Cable, M.D., of Risant; and Benjamin Hohmuth, M.D., M.P.H., of Geisinger Health System in Danville, Pennsylvania — gave value-based care an expansive, mouthful definition in their NEJM Catalyst article, writing that it is a “system that enhances outcomes and access to affordable care by using evidence-based practices, promoting health equity and optimizing the processes of providing and receiving care.”

In his interview with MHE, Ryu described value-based care as “shifting the center of gravity” of healthcare to prevention and away from the emergency department and the hospital. “We believe that if you can identify things sooner upstream, you can keep things in environments without having them go into those acute settings, institutional settings and so forth,” he said.

Ryu and his colleagues describe Kaiser Permanente’s value-based “platform” as greater than the sum of its parts. They stress that it is not a “collection of discrete solutions” and that “this integration — or systemness — is designed to support high-performing value-based care” in the pluralistic multipayer, multiprovider circumstance they described earlier. Still, according to their account in the NEJM Catalyst article, the rollout to Risant was curated, prioritizing three areas: simplifying and making clinicians’ jobs easier; driving evidence-based care more consistently; and the often-mentioned “right” triad — the right care at the right place at the right time (Ryu and his colleagues wrote “in a timelier way” rather than “right time”).

The “clinician simplicity” effort includes an ambient clinical assistant tool that records patient-provider interactions and generates a clinical note, as well as an inbox management tool that uses time to resolution as an outcome measure as opposed to “first response” or “handle time.” The evidence-based care push centered on value-based care guidelines. The intelligence triage tool and Kaiser Permanente’s “Care Without Delay” management system, which has 21 elements grouped into five categories, were intended to achieve the triad of the right care, right place and right time .

In his interview with MHE, Ryu acknowledged that applying Kaiser Permanente’s value-based care practices to Geisinger and eventually Cone is akin to providing wellness classes to people who are already fit and physically active: Ready and willing adopters are often those least in need of whatever is being offered. Ryu described the current pair of Risant health systems as “fertile ground.”

“I think that’s really the magical combination,” Ryu said. “You have the fertile ground but at the same time overlaying and bringing into that environment even better and more consistent tools to make that job even easier.” Ryu said some change management was to be expected but that the prevailing ethos and culture at the Risant health systems led to acceptance and uptake.

Specialty care is next

The NEJM Catalyst article says that leaders at Cone Health are planning to use Risant’s resources and tools, including value-based care guides, an ambient clinical assistant tool and the Care Without Delay program. Also in the next steps are bringing the value-based practices to specialty care, with maternity, oncology and palliative care. “We know that there’s a lot that has been successful at Kaiser Permanente around bringing tools to expecting mothers and making it easier for them to follow their prenatal path,” Ryu said in his conversation with MHE.

In all three specialty areas, there tends to be a lot of variation, he said, and therefore opportunity for improving care for patients. “It’s the same concepts, the same kind of guidelines that we know can be helpful in making the right thing to do the easy thing and creating systemness around the care teams but also around the patients,” Ryu said.