Physician Alignment

Physician Alignment

Our Approach

Navigating Behavioral Change to Improve Clinical Outcomes

Health systems and physicians have a unique relationship. Physicians make decisions regarding patient care, which impacts the financial viability of the health system. Physicians look to provide optimal care and often resent hospital-generated guidelines they were not a party to creating which seem to impact care by reducing costs. Thus, a conundrum is created: aligning the goals and aspirations of both the health system and providers to create sustainable programs to enhance patient outcomes while improving financial performance.

Value Based Enterprise

Dynafios has the expertise and experience to help clients both set-up Value Based Enterprises, as well as assist in managing the success.  With years of experience in working with both health systems, payors and providers the Dynafios team can deliver a winning alignment strategy to drive results.


We have established co-management agreements for key services lines such as general medicine, cardiovascular, oncology, orthopedics and surgical services. Our process begins with setting expectations and developing a shared vision among physicians and hospitals. While there are many details to work through, the overall structure of a co-management arrangement is straightforward.

Dynafios Co-Management Approach

  • Program Assessment The initial step in establishing a co-management agreement is to evaluate opportunities for both quality, financial and operational improvements. 
  • Physician ParticipantsThe next step is to appropriately identify those physicians that are critical to the program and will be key participants in improving performance through the co-management process.  
  • Management DutiesDetermining the scope of the management duties is critical to the process of identifying the FMV compensation for payment to the physicians. 
  • Valuation LettersImportant to any physician compensation for services is establishing the FMV for the level of work and the scope of the management duties. Critical to the process is to ensure the KPI’s or indicators are commercially reasonable.
  • Physician Education Dynafios utilizes an initial kickoff meeting to not only educate key stakeholders on co-management, but to also initiate the process of designing the contract and indicators critical to the success of the agreement. 
  • Negotiation of Terms From the initial meeting to the kickoff, this is the time the Dynafios team works with local counsel and each of the physician managers to appropriately negotiate the terms of the agreement.  
  • Indicator Definition A proposed list of indicators spanning 3 years is presented to the physicians and hospital executives.  The indicator specifics include population criteria, numerator and denominator definitions, baselines, anticipated goals and any exclusionary criteria that might apply.  Finally, there is a measurement period established that reveals the timing of “on the clock” for results to achieve the bonus compensation. 
  • Finalize Contract & Kick Off Dynafios works with all parties to successfully finalize the terms to execute an agreement. Just 90 days from start to kick-off. 

Physician Contract Compliance Including FMV Opinion Letters

Ensuring all of your bases are covered…Mitigating risk with physician agreements.


With healthcare business arrangements growing increasingly complex and financial reporting of healthcare organizations under heightened scrutiny, fair market valuations (FMV), auditing and contract adjudications are more important than ever before.


Our team of senior appraisers utilize both national and proprietary databases for FMV opinion letters in a variety of business, contractual and asset valuation work. From FMV opinion letters to contract adjudications, we have an experienced team that can provide the third-party review for all your compliance needs.


In addition to our compliance services, Dynafios also offers software products that help reduce compliance risk with physician agreements. The DYNAFIOS APP is an easy to use physician timekeeping and contract compliance app that helps ensure all contractual relationships are compliant and within FMV.

Value Based Enterprise – Limited Risk

With recent changes to the Stark and AKS statutes created by the Regulatory Sprint to Coordinated Care, providers have a significantly increased ability to move towards higher quality, value-based care arrangements. With the simple requirements of a Value Based Purpose, Value Based Enterprise, Value Based Arrangement and Value Based Activities, organizations can now manage target patient populations in tighter care coordinated protocols.

Who can be a Value Based Enterprise (VBE)?

A VBE can be considered a network of providers engaged in value-based activities. Any type of organization can be a Value Based Enterprise, including CIN, ACO or other contractual professional services agreement. VBE’s must have an accountable body or person who is responsible for the financial and oversight of the VBE and a governing document that describes the VBE, the purpose and participant’s intent to achieve the value-based outcomes. VBE must have a target patient population selected using legitimate and verified criteria defining the need for improvement.

What is a Value Based Purpose?

The Value Based Purpose must include one of four (4) purposes:

  • Care coordination
  • Quality of care improvement
  • Reduction of cost without reducing quality
  • Transition in payments from volume to value for care delivery

What is a Value Based Arrangement?

Written agreement specifying the target patient population and value-based activities to achieve the VBE purpose. It must include the target population, description of the remuneration, and term of the agreement.

What is the Benefit of a Value Based Enterprise?

Structuring relationships with providers through a VBE provides new opportunities to target activities related to care coordination, directed referrals, and cost standardization given the new AKS and Stark safe harbors and exceptions. Partnering with post-acute providers can now include in-kind remuneration such as cost sharing for Care Coordinators. Direct referrals to specific providers or suppliers are allowed for the target patient population.

Why Dynafios? OR How Do I Get Started?

Dynafios has decades of experience in bringing together providers and organizations to create higher quality care and cost predictability across a variety of settings and patient populations. Our clinical consulting team brings the latest evidence-based practices and works with providers and other clinical staff to implement and track improved outcomes.

Results Driven

Founded in 2004 Dynafios continues to grow and expand throughout the healthcare industry assisting clients in the areas of physician alignment, analytics and compliance services.  With a seasoned team of analysts and consultants, Dynafios closely works with each client to improve the clinical process of care, patient experience, operational efficiencies and outcomes…all critical in a value-based purchasing environment!​  Our innovative products 4CAST and The DYNAFIOS APP provide clients the ability to understand clinical variation, provider performance and help organizations efficiently manage time activities that require payment for services.

  • Tina Brinton

    Chief Operating Officer

    Tina Brinton serves as the Chief Operating Officer at Dynafios. With more than four decades in healthcare, Tina brings a strong leadership style to drive results and ensure the Dynafios team delivers unwavering results.

    Tina holds a Bachelor’s Degree in Nursing from Missouri Western State University and is a highly respected thought leader throughout the healthcare industry.

  • Cassandra Couey, MSN, RN

    Senior Consultant

    With nearly two decades in healthcare, Cassy has a wide range of experience including critical care, emergency care, surgical care, cardiovascular care, leadership, and quality.

    Cassy received her Bachelor of Science in Nursing from the University of Texas at Arlington and her Master of Science in Nursing with an emphasis in Health Informatics from Grand Canyon University. 

  • Heather Lorenz, MSN, BSN

    Senior Consultant

    Heather has acquired more than 20 years in healthcare, with 15 years in clinical leadership roles in neurovascular, emergency, critical care, telemetry and patient logistics center. Heather’s experience includes service line manager of a multiple hospital system neuroscience program and Level 2 trauma center. She has acquired considerable experience developing programs to reduce risk and enhance clinical outcomes, and increasing satisfaction among patients, providers and clinical staff. In her consulting career she has led many engagements for a variety of service lines.

  • Kelly Witter, MSN, RN

    Senior Consultant

    Kelly Witter, MSN, Senior Consultant brings over 25 years of healthcare experience with 20 years in senior leadership positions. Kelly demonstrated success in standardizing operations, evaluating compensation, onboarding new providers, and building a team of physicians that led the physician network through a formal physician leadership council. Kelly is known as a subject matter expert in oncology, palliative care, hospice, women health, pediatrics, hospital medicine, and provider networks. She is also a faculty University teaching in the nursing and health science programs.