An Honest Perspective from Jessi Gordon, VP and General Manager, NY Market, and Soumya Mamidala, Vice President, Government Programs.
Value-based care is a bipartisan bridge in healthcare reform
With the Trump administration taking shape and establishing its priorities, healthcare policy is under renewed
scrutiny, bringing costs, access, and quality back into the national spotlight — both in Washington and across the
headlines.
Partisan divides define many political issues today, but the core principles of value-based care offer a rare point
of consensus across the political arena. Legislators across the aisle acknowledge that our current system’s fee-
for-service model has contributed to unsustainable costs without delivering better patient outcomes for many
Americans.
Although Republicans and Democrats may differ in their approach to policy reform, the goal is clear: the U.S.
healthcare system requires a fundamental shift from a model that rewards volume to one that prioritizes and
incentivizes high quality care while managing costs.
Ultimately, everyone wants the same thing — great care from trusted providers at prices patients can afford,
and a system where physicians can take pride in the care they deliver and the impact they make on their
patients’ health.
Why value-based care matters to policymakers
Healthcare costs and quality remain top concerns for both parties. Policymakers recognize key challenges
shaping the future of healthcare:
- The rapidly aging population — often called the “silver tsunami” — is driving up demand for care.
- The burden of chronic disease is growing.
- Healthcare spending is rising faster than inflation.
- High healthcare spending fails to guarantee better quality, particularly for populations with limited
access to care.
Value-based care offers common ground by addressing these issues in ways that align with priorities from across
the political spectrum.
This rare alignment across political philosophies gives a clearer path forward with confidence that the shift
toward value will continue — regardless of which party holds power.
Spotting the signals
As the first 100 days unfold, early policy signals and CMMI program changesare already providing clues for health systems, providers, and care teamsparticipating in value-based models.
What we know so far
Medicare Advantage: The administration is expected to favor broaderadoption of Medicare Advantage, reinforcing the emphasis on privatesector flexibility and innovation to control costs and improve care. At thesame time, there will be continued attention placed on coding andpayments.
ACO REACH: The administration is assessing the extension of ACO REACHbeyond 2026. The renewed focus on achieving savings through CMMImodels may suggest a restructuring of the model with reducedadministrative burden while preserving core elements like flexibility andupfront payments.
What this means for our partners
The fundamental shift toward value-based care isn’t slowing down, but howprograms work — and how success is measured — could evolve, particularlywith the new administration’s focus on saving money. Staying ready meanskeeping your operational processes flexible, your data reporting strong, andyour financial planning adaptable to shifting payment models.
The Honest Health team is actively monitoring these plausible shifts,analyzing their impact, and translating happenings into clear guidance forour partners. Our goal is to help you anticipate change, not just react to it,and ensure you can confidently participate in evolving programs.
What we’re watching
Medicare Advantage Expansion
Potential incentives for broaderparticipation and higherperformance standards.
ACO REACH Restructuring
Upcoming decisions aroundprogram extension, updatedrequirements and evolution toreduce administrative burden whilemaintaining provider flexibility.
Streamlined Reporting & Quality Requirements
Policymakers aim to make VBCparticipation easier, especially forsmaller practices.
Payment Accuracy in Medicare Advantage
Increased scrutiny on riskadjustment and paymentmethodologies.
New Payment Models on the Horizon
Expect interest in capitation,episode-based payments, anddirect contracting to grow.
Navigating risk in a shifting policy environment
For partners participating in ACO REACH or MSSP, the conversation isn’t just about national shifts — it’s about ensuring these programs work effectively for your organization and your patients. Both remain central to Medicare’s value-based strategy, but each program offers a different approach to balancing risk, reward, and operational complexity.
ACO REACH adjustments
Although no formal announcements have come from this administration, CMS previously confirmed several changes participants should anticipate:
- Larger upfront discounts for fully capitated participants.
- Stricter cost benchmarks, raising performance expectations.
- Greater focus on model sustainability and risk management.
With ACO REACH under review, we encourage partners to carefully assess their risk-sharing options, balancing short-term modifications with long-term infrastructure investments that position the organization for success in any value-based model.
Comparing models in the risk journey
For some organizations, MSSP offers a more familiar path, especially for those seeking lower risk participation in Medicare’s value-based care programs. For others, ACO REACH creates opportunities to drive innovation, better manage cash flow, and test more flexible care delivery approaches.
Use this side-by-side comparison to guide your internal discussions:
| ACO REACH | MSSP | |
|---|---|---|
| Risk Level | Professional (50%) or global (100%) risk | Varies ranging from upside-only models to two-sided risk up to 75% |
| Payment Model | Prospective monthly payments from ACO with financial settlement after PY | FFS payments from CMS with retrospective financial settlement |
| Flexibility | Enhanced care delivery innovation and benefits (telehealth, home visits, part B cost share, home health waivers, etc.) | Established MSSP benefit programs (3-day SNF waiver, telehealth, and beneficiary incentive) |
| Cash Flow | Real-time payments to the ACO provide flexibility to support quality incentives in-year | Performance-based payments after year-end reconciliation |
What our partners should keep in mind
While no one can predict exactly how future policies will evolve, the ability to continually evaluate and adjust your strategy is essential for success.
Whether your primary care organization is fully committed to ACO REACH, exploring MSSP participation, or considering both alongside other models as part of a broader risk strategy, it’s essential to maintain clear visibility into your data, performance metrics, and operational readiness.
Our team works alongside partners to evaluate program performance, model future scenarios, and fine-tune strategies — helping you stay ahead of shifting policies while keeping your focus on delivering exceptional care.
Medicare Advantage: balancing opportunities and oversight
Medicare Advantage remains central to the Trump administration’s healthcare strategy given over half of the country’s Medicare population is enrolled in Medicare Advantage plans. The administration is expected to leverage private sector innovation to drive cost control, care access, and benefit flexibility. This focus aligns with long-standing Republican healthcare principles that emphasize competition-driven cost management.
At the same time, Medicare Advantage’s rapid growth and rising costs have drawn increased scrutiny from both sides of the aisle. With more than half of all Medicare beneficiaries now enrolled in Medicare Advantage plans, ensuring payment accuracy, compliant risk adjustment, and program integrity has become a policy priority. This combination of encouragement and oversight creates both opportunity and strain for health systems and provider organizations.
For many of our partners, Medicare Advantage presents a promising pathway to expand lives under management and deliver better outcomes for senior patients. However, success requires a comprehensive approach — one that aligns clinical and financial strategies, strengthens care coordination, and ensures accurate documentation. As expectations evolve, organizations that take a proactive stance in optimizing performance will be best positioned to navigate the landscape effectively while continuing to provide high-value care.
What’s next for Medicare Advantage
Past and present administration actions, along with an executive order on drug pricing, are already reshaping parts of the Medicare Advantage landscape — as well as areas of Traditional Medicare.
What’s happening now:
- Reminder requirements for unused benefits: Medicare Advantage plans are now required to proactively notify members about unused supplemental benefits, such as dental, vision, and wellness programs. This is intended to improve member engagement and satisfaction while ensuring that they get critical preventive and wellness care.
- Tighter scrutiny of risk adjustment: With Medicare Advantage spending under review by the Senate Finance Committee, expect closer examination of how risk scores are calculated and how plans and providers document clinical complexity. This type of scrutiny often cascades downstream to participating providers, leading to increased documentation audits and greater demand for coding precision.
- Part D out-of-pocket cap: The new $2,000 out-of-pocket cap on Part D prescription drugs took effect this year. This is a major shift designed to reduce financial barriers for both Medicare Advantage and Traditional Medicare beneficiaries managing chronic conditions, especially those who rely on expensive medications.
- Executive order rolling back drug pricing measures: Early this year, President Trump signed an executive order rolling back several drug pricing measures introduced under the prior administration, shifting focus back toward market-driven pricing. This rollback, also pertaining to both Medicare Advantage and Traditional Medicare, paused planned changes to Medicare’s drug purchasing programs and removed certain copay caps for beneficiaries. While these changes primarily affect payers, they also shape how plans manage pharmacy spending and could indirectly influence contracts and formularies moving forward.
Key considerations for our partners
Medicare Advantage will continue to evolve under the current administration, shaped by support for its private-sector flexibility alongside growing scrutiny over program costs and payment accuracy. For health systems and providers, success depends on more than delivering high-quality care — it also requires smart contracting with Medicare Advantage plans, clear communication with participating providers, effective performance strategy, an understanding of the local healthcare landscape, and a strong patient engagement strategy.
Staying informed about policy updates, understanding how changes affect plan expectations, and ensuring your teams are equipped to adapt will be critical. These steps help ensure both financial stability and strong performance in a risk-based model.
What it all means
While politicians may debate the details in Washington, the work of delivering value-based care happens at the front lines — in your practices and organizations. At Honest Health, we know that healthcare is local.
- Patients expect affordable, accessible care that’s easy to navigate.
- Providers want to focus on clinical excellence, not administrative complexity.
Value-based care offers a framework to align these interests, but success depends on how well organizations translate policy into strategy. That’s why understanding what’s ahead — and having the right partner to help you plan for it — matters more than ever.
Looking ahead
As always, the why behind value-based care remains the same: ensuring high-quality, cost-effective care while improving outcomes for both patients and providers. This vision continues to resonate with policymakers from both parties — and it will continue to drive healthcare reform, regardless of who is in office. While the Trump administration’s approach will differ from Biden’s, one thing remains true: healthcare spending in this country does not align with the outcomes for patients.
At Honest Health, we believe success requires more than clinical excellence. It demands operational readiness, financial safeguards, and data-informed decision-making that can evolve alongside policy changes.
For our partners, that means:
- Maintaining operational flexibility to adapt to new program requirements.
- Strengthening data and reporting capabilities to meet quality and performance standards.
- Building financial resilience to weather payment shifts and cash flow uncertainties.
- Working collaboratively with payers to develop strategic contracts
We understand the weight of these responsibilities. Our role isn’t just to inform you of change — it’s to help you plan, adjust, and succeed in it.
Whether you’re weighing your options within MSSP, considering a move to the restructured ACO REACH program, or exploring risk models with Medicare Advantage plans, our team is here to help you make confident, well-informed decisions.
As your partner in value-based care, we’ll continue to monitor regulatory changes, advocate for policies that work for our partners and your patients, and deliver the insights and guidance you need to stay ahead.
Sources:
Centers for Medicare & Medicaid Services (CMS), “ACO REACH Model Overview,” Updated 2024, https://innovation.cms.gov/innovation-models/aco-reach
Centers for Medicare & Medicaid Services (CMS), “Contract Year 2025 Medicare Advantage and Part D Final Rule,” May 2024, https://www.cms.gov/newsroom/fact-sheets/contract-year-2025-medicare-advantage-and-part-d-final-rule
CMS Innovation Center (CMMI), “Advancing Health Equity in ACO REACH,” Updated 2024, https://innovation.cms.gov/innovation-models/aco-reach
Health Affairs, “Bipartisan Support for Value-Based Care: What History Tells Us,” December 2024, https://www.healthaffairs.org
Kaiser Family Foundation (KFF), “The Long Road to Value-Based Care,” Updated 2024, https://www.kff.org
Kaiser Family Foundation (KFF), “The Medicare Part D Cap Explained,” January 2025, https://www.kff.org/medicare/issue-brief/explaining-the-medicare-part-d-cap
MedPAC, “Medicare Payment Policy: Report to Congress,” March 2025, https://www.medpac.gov
Modern Healthcare. “Trump Administration Signals Renewed Focus on Medicare Advantage.” Published January 2025. Available at: modernhealthcare.com
National Association of ACOs (NAACOS), “Timeline of Value-Based Care and ACO Policy Evolution,” 2025, https://www.naacos.com
STAT News, “Senate Finance Committee Targets Medicare Advantage Risk Adjustment Practices,” February 2025, https://www.statnews.com
The White House, “Executive Order on Lowering Prescription Drug Costs,” January 2025, https://www.whitehouse.gov