Accountable Care & Value-Based Care: What Every Physician and APC Needs to Know

Why Healthcare Is Moving to Value-Based Care

By Kevin McNeill, MD, MHA, Medical Director LVACO

There has been renewed momentum toward value-based healthcare in the past 2 years. This is driven by growing economic pressures which have spurred an increase in CMS policy changes that support and advance value based financial models. This renewed interest is facilitated by maturing data analytics and experience in population health management. There is also mounting evidence that certain value-based models improve outcomes while moderating cost. (Conway, et al., 2023)

Rising economic pressures include higher healthcare costs due to an aging population, an increase in the prevalence of chronic disease, work forces shortages, persistent health disparities, and a fragmented healthcare system. (Almodaimegh et al., 2025). Tightening margins have forced health system leadership to re-engage with value-based healthcare as a potential solution to this challenging environment. (HFMA, 2025).

A well-known concept in healthcare is the Triple Aim: “Improving the U.S. healthcare system requires simultaneous pursuit of three aims: improving the experience of care, improving the health of populations, and reducing per capita costs of health care.” (Berwick, et al., 2008).  This concept is foundational to value-based care. It also exposed a fundamental problem in the financing of health care.

Fee-for-service, the model that has predominated in healthcare financing in the US for the past 80 years, creates financial incentives for a greater quantity of services delivered, whereas value-based healthcare links payment to quality, outcomes, patient experience, and cost-effectiveness (HFMA, 2025)

CMS continues the direction of prior administrations toward value-based care. Medicare to expand accountable care arrangements and alternative payment models that reward quality, outcomes, prevention, and cost efficiency rather than the volume of services delivered. CMS has emphasized population health, care coordination, and patient-centered care through initiatives such as the Medicare Shared Savings Program, while continuing to develop new models focused on chronic disease management and prevention. Together, these efforts reflect Medicare’s ongoing transition from fee-for-service reimbursement toward a system aligned with the Triple Aim of improving patient experience, improving population health, and reducing healthcare costs. (CMS, 2025).

 

Sources:

Conway, S. J., Kuye, I. O., Yeatts, J., Jaffery, J., & Berkowitz, S. A. (2023). Transforming health care from volume to value: Moving the needle through population health. The American Journal of Medicine, 136(9), 874-877. https://doi.org/10.1016/j.amjmed.2023.03.021 [amjmed.com]

Almodaimegh, H., Abu Esba, L. C., Alabdan, N., Alakeel, Y. S., Alharbi, M., Aldekhael, S., & Almajed, K. (2025). Transforming healthcare: A scoping review of the significance of value-based healthcare. Global Journal on Quality and Safety in Healthcare, 8(4), 161-169. https://doi.org/10.36401/JQSH-25-4 [pmc.ncbi.nlm.nih.gov]

Williams, J. (2025, November 3). Value-based care adoption grows, but challenges remain. Healthcare Financial Management Association. https://www.hfma.org/reference/value-based-care-adoption-challenges/ [hfma.org]

Berwick, D. M., Nolan, T. W., & Whittington, J. (2008). The triple aim: Care, health, and cost. Health Affairs, 27(3), 759-769.

Centers for Medicare & Medicaid Services. (2025). Strategic direction: CMS Innovation Center strategy. U.S. Department of Health and Human Services. https://www.cms.gov/priorities/innovation/about/strategic-direction