Health system leaders are navigating one of the most consequential transitions in modern healthcare: the shift from volume-driven care to value-based models focused on population outcomes.
At the same time, the pace of change is accelerating. New models from CMS and CMMI continue to emerge, timelines remain compressed, and expectations for performance are evolving.
At Honest Health, we work closely with providers and health systems navigating this shift every day. Recently, we sat down with Soumya Mamidala, VP of Government Programs Strategy & Advocacy, to explore what leaders need to prioritize — and where many organizations get stuck.
One theme came through clearly: Success in value-based care is not about selecting a single model. It’s about building the capabilities to perform, regardless of the model.
From volume to value requires a fundamental redesign
The transition to value-based care is often framed as a change in reimbursement. In practice, it is far more fundamental — it requires rethinking how care is designed and delivered.
“Value-based care is about moving away from all of the tactical things providers have to do to drive volume — more visits, more patients — and instead asking: How do we design a system that actually makes our populations healthier?”
This shift challenges long-standing operating models built around throughput and utilization. Instead of optimizing around volume, health systems must focus on outcomes, prevention, and total cost of care.
Primary care plays a central role in this transformation.
“When patients are getting care, their primary provider is the quarterback. They know the whole picture and help patients navigate a system that is incredibly complicated.”
But as many organizations are discovering, primary care alone cannot carry the full weight of this transformation.
Integration — not isolation — drives performance
To meaningfully impact cost and outcomes, value-based care must extend across the full care continuum.
“Specialists represent a significant share of healthcare spend. It’s impossible to design value-based care without meaningfully integrating them.”
Patients don’t experience care in silos. They move between primary care and multiple specialists, often without clear coordination.
Without alignment across providers, health systems have limited ability to manage outcomes at scale.
New models are beginning to support this more directly — introducing new mechanisms to bring specialists into value-based arrangements and better coordinate care delivery. But these tools only matter if organizations actively redesign how care is delivered across settings.
As care models become more integrated, the decisions around where and how to participate are becoming more complex.
In a rapidly evolving landscape, flexibility is a strategic advantage
The current environment is defined by rapid change.
“We’re seeing so many new models coming out, a lot of variation in how groups can participate — and it’s all happening on really short timelines. That’s a lot for systems to take in all at once.”
For many leaders, the challenge is not whether to participate, but how to make informed decisions in an environment that continues to evolve.
A more effective approach is to prioritize flexibility early in the process.
“It’s best to keep your options open, apply, and then make decisions as more information comes in about what will actually work for your organization.”
This approach allows organizations to preserve strategic pathways while evaluating financial scenarios, operational readiness, and model fit.
But flexibility in the near term must be balanced with clarity about what these decisions require over time.
Model selection carries real operational consequences
One of the most common misconceptions we see is treating model participation as a discrete decision point, rather than an ongoing operational commitment.
“These models are not short-term. You’re going to be participating in them for a while and really building infrastructure around them — so it’s important to think about what your performance could look like over time.”
Whether in MSSP or longer-duration models, success depends on sustained commitment to care delivery, data infrastructure, and organizational alignment.
This is where actuarial modeling becomes critical.
“Actuarial modeling looks at your providers, your patients, and your historical data to assess what performance could look like — and then layers in the mechanics of the model to show how those decisions play out over time.”
With that insight, organizations can better understand long-term risk, evaluate different scenarios, and align participation with their broader strategy. This allows for informed decision-making on care delivery initiatives can actually drive savings.
Without it, decisions are often made without a clear understanding of how performance will evolve.
Participation is easy. Performance is not.
Entering a value-based care model is not the same as succeeding in one.
“It can be easy to participate in a model where you don’t have to change anything. But if you take that approach, you won’t continue to perform well — eventually, you’ll see negative financial impacts.”
Performance requires intention.
It requires understanding your population, designing targeted interventions, and continuously adapting how care is delivered.
It also depends on engagement — particularly from providers.
“Patients listen to their doctors. If providers are engaged in value-based care, patients will get engaged too.”
Without that alignment, even well-designed models struggle to deliver meaningful outcomes.
At the same time, even the strongest execution strategies operate within a broader external environment.
Policy will continue to shape the path forward
The evolution of value-based care is closely tied to policy — and those shifts can have real implications for organizations on the ground.
“These models are designed to be tested and refined over time, with CMS relying on feedback from participating organizations to determine what works.”
Policy decisions — sometimes outside of provider control — can have significant downstream financial impacts. But they also create opportunities for organizations to engage, provide feedback, and help shape how models evolve.
More broadly, the direction is clear: increasing accountability, greater alignment between reimbursement and outcomes, and a continued shift toward value-based care as a core component of the healthcare system.
Build for the future while delivering today
Health systems are operating in a moment of meaningful transition. Participation in value-based care is expanding, expectations are increasing, and the definition of success is evolving.
Across the healthcare organizations we work with, those making the most progress are those that:
- Think beyond individual models
- Build capabilities that support performance
- Maintain flexibility while making disciplined decisions
- Align care delivery across providers
- Engage your providers in the entire process
Above all, they recognize that transformation takes time.
“Value-based care is a marathon, not a sprint. You apply interventions, and they don’t show results on day one — but over time, you start to see the impact across your population.”
Organizations that approach this shift with discipline, strategic clarity, and a level of patience will be best positioned to succeed — not just in participating, but in truly transforming how care is delivered.