Proving your value is just as important as creating it

Providers often do the hard work of transformation but struggle to get credit from payers. Showing measurable impact is critical.

Use a data-driven pitch deck when negotiating with payers. "Value-based contracting is contracting for the value that you're creating," said Shufelt. The deck should include proof points on total cost of care, quality outcomes, and clinical documentation — benchmarked against market and competitors.

"This is where you start to leverage the data and analytics," he added. "Ideally where you are versus the market, where you are versus your competitors — having that line of sight becomes really important when you're sitting down with a payer."

Risk is a two-way street

Treat VBC as a partnership strategy. "Payers are enablers," said Shufelt. "They've got the data… the core things that you're going to need to be successful."

Health plans must also recognize the value of provider-patient relationships.

This shift requires both sides to align around shared goals for cost, quality, and patient experience.

Technology is the engine — not the accessory — of VBC

When disruptive tools — like AI, personalized outreach, and real-time clinical insights — are fully integrated, they transform care delivery.  "Technology is not an accessory to value-based care — it's the engine," said Chouinard. He described a future where providers begin their day with a VBC "journal" that integrates patient data, risk assessments, and care recommendations.

"It's about using a lot of the insights for what's the best next action for patients… More and more, these interactions are going to be automated," he said.

Generative AI could be transformative. "The change that we're going to be seeing is how Gen AI is being used to deliver care… is probably as important as when we went digital in the first place," said Chouinard. These technologies can automate documentation, surface real-time insights, and personalize patient outreach — dramatically improving both provider efficiency and patient experience.

But the infrastructure isn't there yet. "We don't have the same type of platform—integrated overall and really all-encompassing — that we've had in the fee-for-service world," he cautioned.

Long-term outcomes may not resonate with stakeholders focused on short-term financial performance. "It can't be reducing utilization five or ten years down the road," he said. "That's not going to resonate with the risk-bearing entity that's trying to manage cost this year."

Commercial VBC faces structural challenges, including fragmented risk-bearing entities and employer churn. "It cannot be about underwriting," said Reuter. "We need to have an impact on cost and quality — real cost, real quality."

Act now — demographic and financial pressures demand urgency

The "silver tsunami" of aging Medicare-eligible patients is accelerating demand for sustainable care models. "You're not going to negotiate your way to sustainability… it's going to come through value-based care incentives," said Shufelt.

"If you don't manage this population… they're going to fill up your beds with low acuity medical admissions that you don't have any margin on," he added. In this context, VBC isn't just a strategic initiative — it's a financial imperative.

Rising commercial costs will also drive adoption. "This is going to create tremendous pressures," said Reuter. He's encouraged by the growing demand for measurable outcomes. "Can we value, as actuaries, the effectiveness of our solution? What value are we bringing to the patients that we are looking to have impacts on?"