This article is sponsored by Theoria Medical. This article is based on a Skilled Nursing News discussion with Kevin Murphy, CEO of Theoria Medical. The discussion took place on August 19, 2025 during the SNN RETHINK Conference. The article below has been edited for length and clarity.
Skilled Nursing News: I’m excited to kick off this session. It’s a great topic: Transforming Senior Care—A Value-Based Approach to Quality and Outcomes. I’m joined today by Kevin Murphy, CEO of Theoria Medical.
Kevin is an accomplished entrepreneur and healthcare executive with more than 14 years of expertise in value-based and in-home care. Over his career, he’s launched 10 new accountable care organizations (ACOs) and developed diversified value-based care strategies for multiple organizations. At Theoria Medical, he has historically led strategy and innovation to improve clinical outcomes and reduce costs for complex patient populations.
Theoria is a leader in tech-enabled, value-based primary care and is working to revolutionize healthcare for senior living communities nationwide.
So Kevin, let’s start here: “Value-based care” is a term that gets used a lot. It’s been mentioned frequently at this conference, but it can mean different things to different people. To level-set, can you define what value-based care means in the context of long-term care, and how it differs from traditional fee-for-service?
Kevin Murphy: Thank you, it’s a pleasure to be here today.
When I talk about value-based care, I’m thinking about the primary care physician and how they manage value for patients—more of an indirect relationship with facilities. CMS has set a goal for 100% of primary care physicians to be in a value-based care model by 2030.
In essence, value-based care means the provider is paid based on quality, not volume. That’s the key mechanism. There are other components, but at its core it’s about how providers are reimbursed for the relationship with their patients.
There are obviously many different value-based care models. Which ones are most relevant to skilled nursing and long-term care?
From the primary care perspective, I think about models like ACO REACH, the Medicare Shared Savings Program, traditional ACOs, and Institutional Special Needs Plans (I-SNPs).
There are also community-based ACOs that involve hospitals, payers, and health systems. Those relationships look a bit different but can still drive value—and referrals—to skilled nursing providers.
Can you break down how these value-based care models change the relationship between provider, payer, and facility operators?
Sure. I think about this in two buckets: internal and external.
Internally, you may have a primary care partner within your building who’s participating in an ACO or an I-SNP. That partner’s relationship with patients can drive quality, outcomes, and hopefully shared savings or revenue for your facility.
Externally, you have payers, hospital systems, and community ACOs. The quality achieved in your building directly impacts those referral sources and the value they see in sending patients your way.
And how about the economics—how do ACOs and I-SNPs affect financial performance for long-term care providers?
Economically, it comes down to choosing the right partner.
If you’re aligned with an I-SNP or a group managing risk for your long-term care patients, you should be participating in shared savings. That relationship should include back-end savings tied to outcomes for your patients.
Internally, a strong value-based partner should also help you perform better with payers and health systems, opening up both referral and revenue opportunities.
What operational changes are most important for success in value-based care models?
First, you can’t treat a value-based care relationship like just another contract. If you’re just waiting until year-end to see if there’s savings, you’re leaving results entirely in your partner’s hands.
Instead, facilities need to be actively involved. Ideally, you should have a designated point person in each building who understands value-based care, knows which patients are enrolled, and tracks outcomes. It’s not about treating patients differently—it’s about awareness and proactive management.
When the whole team understands the potential impact, outcomes improve.
I expected you to bring up technology, since capturing and sharing data seems critical. Can you speak to that?
Absolutely—technology is essential.
At Theoria, we use our own EMR that integrates with PointClickCare and Matrix. Having access to that data, along with CMS data, makes us more effective.
But I see this as the partner’s responsibility, not the facility’s. Your partner should bring the right technology to support value-based care, rather than requiring the facility to drive those changes alone.
Theoria Medical is a leader in tech-enabled, value-based primary care, revolutionizing healthcare for senior living communities nationwide. To learn more, visit: https://theoriamedical.com/.
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