The Darwin Value Index
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About the Darwin Value Index
We first created the Darwin Value Index (DVI) in 2016 as a means to score and compare the nation’s integrated health systems’ state of readiness for a value- or outcomes-based payment system.
The DVI measures a health system’s progression from fee-for-service to value based on an average of six measures scored on a 10-point scale. While the index is admittedly subjective, we determine these scores based on multiple interviews with system executives over time and in relation to other integrated health systems.
In addition to the percentage of revenue derived from alternative payment models (APMs) and percentage of physicians employed by the system — versus contracted or by affiliation — we measure four other dimensions to arrive at an average score:
- Quality of vertical integration: the degree to which the health system owns or has high-performing networks of health care delivery channels, such as physician groups, home health agencies, and ambulatory surgery centers
- Technology integration: how integrated the system (hospitals, physician practices, and other delivery sites) is on a single EHR platform
- Payer experience: whether the system has a health plan, how long it has had the health plan, and how many lives are under management
- APM experience: degree of sophistication with ACOs, bundles, and other alternative payment models
As of Q2 2020, the DVI ranges from a low score of 2.5 (Temple Health) to a high of 7.5 (Geisinger).
There are some limitations to our model beyond its subjectivity. First, we only assign a DVI score to health systems that we’ve researched at length; not all of the nation’s largest systems are represented here.
Second, the DVI should be used with caution when applied to the largest multi-state health systems with “subnetworks” of care. In these cases, there may be variability among the subnetworks, such as their experience with APMs, technology integration, and physician employment models.
For example, Greensboro, N.C.-based Cone Health (DVI=5.2), an integrated delivery network within Atrium Health (DVI=5.0), is the most advanced network within the larger system. Other networks within Atrium Health are less advanced based on our scoring criteria.
DVI scores are evaluated and updated by our research team regularly.