By Susan DiMickele, President & CEO, National Church Residences, and Jacob Swint, VP, Strategic Growth & Operations Support, National Church Residences
Value-based care (VBC) has moved from an emerging concept to an operating reality, reshaping expectations around outcomes, cost, and resident experience. Yet many senior living operators are still asking a fundamental question: “What does a strategic VBC partnership look like from the operator’s seat?” In an increasingly complex environment, the distinction between a vendor relationship and a strategic partnership with a primary care group determines whether an operator experiences marginal improvement or a meaningful transformation of their value proposition.
What Makes a Value-Based Care Partnership Truly Strategic for Operators
From an operator perspective, a VBC partnership with a primary care group becomes strategic when it begins with shared accountability. The most effective partnerships align not only around clinical outcomes, but around the metrics operators manage every day: resident length of stay, occupancy, staff turnover, and family satisfaction. If a clinical partner cannot directly influence the operator’s core business drivers, the relationship is unlikely to deliver sustained impact.
A second hallmark of strategic partnership is the presence of a deeply integrated clinical model tailored specifically for senior housing. Across the National Church Residences portfolio and our primary care medical group, At Your Door – Visiting Healthcare Services, we have seen the effectiveness of onsite primary care teams supported by physicians, advanced practice providers, registered nurses, care managers, and social workers. This interdisciplinary structure reduces unnecessary emergency department use, improves continuity of care, and supports the “Quadruple Aim” of enhanced care quality, lower cost, improved experience, and reduced staff burnout.
Most critically, strategic partnership requires aligned incentives and shared value creation. For years, external medical groups have operated within senior housing but retained most of the economic upside associated with VBC performance. Yet senior living operators have been creating value for decades through stable housing, early issue identification, and daily resident support. A true partnership recognizes this contribution by offering operators a meaningful seat at the table, including the ability to participate financially in VBC outcomes.
How to Approach Partnership Strategy in a Still-Evolving VBC Landscape
The VBC landscape continues to evolve with new payment models, shifting benchmarks, and increasing expectations for risk management. Operators cannot rely on prediction alone; they need partnerships that are flexible, resilient, and prepared for what’s next.
Operators should look for partners with experience across multiple reimbursement arrangements and the ability to manage risk, matching the operator’s readiness rather than forcing a one-size-fits-all model. They should also prioritize partners who are willing to provide them with access to VBC programs, especially as many operators lack the capital or internal expertise to develop clinical capabilities in-house.
The right primary care partner lowers the barrier to entry by providing the infrastructure, compliance, reporting, and staffing necessary to support the operator while enabling operators to stay focused on resident experience, staffing, and community operations. When done well, these partnerships can unlock an additional revenue stream for the senior living operator while strengthening key business outcomes including occupancy, length of stay, and staff retention.
Reflections to Help Leaders Form Partnerships More Intentionally
Several observations can guide operators as they evaluate potential VBC partners:
- Start with the “why,” not the reimbursement model. Anchor decisions in resident needs, operator pain points, and long-term goals.
- Prioritize operational integration. The clinical team must become part of the community’s daily rhythm and not a visiting external entity.
- Demand radical transparency. Data access, performance review, and shared decision-making are non-negotiable in VBC.
- Shared financial participation. Operators should insist on direct participation in financial upside.
- Evaluate cultural alignment. Trust, mission fit, and communication often matter as much as clinical expertise.
- Consider risk management and risk tolerance. Understanding a partner’s ability to manage, share, and communicate risk exposure is essential for long-term sustainability in VBC.
The senior living industry is at a pivotal moment. VBC-aligned primary care partnerships are no longer experimental. They are becoming foundational infrastructure for the future of senior living. It is no longer a question of “if” a senior living operator should be participating in VBC programs and a matter of “how”. Organizations like NIC are essential in educating and convening leaders around this shift so operators can finally be recognized and rewarded for the value they have been creating for decades.
