The Untold Secrets of Value-Based Contracting: Where Plan-Provider ROI Hides

Insights from the AHIP MMDC 2026 Panel on Operationalizing Value-Based Care

Value-based care has been discussed for over a decade, but scaling it in a way that consistently delivers ROI for both plans and providers still remains elusive. 

At AHIP MMDC 2026, one of the most well-attended panels took an unconventional approach—focusing on real industry success stories and surfacing challenges often left unspoken. In “The Untold Secrets of Value-Based Contracting: Strengthening Plan-Provider Partnerships Through Operational Enablement and AI,” industry leaders came together to unpack why—and more importantly, the tips and tricks of what’s actually working. 

This discussion challenged the status quo. It moved beyond contract modifications and reactive adjustments into a deeper conversation on what actually drives ROI: operations, alignment, and execution. 

Here are a few of the key themes/takeaways that were discussed: 

1) The Real Barrier Isn’t Strategy, It’s the Enterprise Business Case 

One of the most candid insights was that value-based care often destroys revenue before it creates it. 

Fee-for-service declines faster than value-based revenue ramps up, creating a capital gap that health systems struggle to absorb. This means: 

• Success requires an enterprise-wide business case, not isolated contracting efforts 

• Alignment across health plans, provider networks, and hospital finance teams is critical 

• Transparency into revenue impact, savings, and provider performance matters more than contract terms alone 

Without this, even well-designed contracts fail to scale. 

2) Organizational Silos Are Quietly Killing Progress 

Many organizations aren’t failing because of poor intent. They’re failing because of structure (or lack thereof). 

Clinical, network, and operational teams often function in silos, leading to: 

• Fragmented decision-making 

• Loss of institutional knowledge 

• Misaligned incentives 

At the same time, reliance on spreadsheets and disconnected tools creates: 

• Administrative bloat 

• Redundant work 

• Limited real-time visibility 

This means value-based care is a coordination problem as much as a financial problem. 

3) Mutual Provider-Plan Trust Still Isn’t There  

Providers don’t trust the data or the process. But why? Some of the reasons most often cited include: 

• Delayed or unclear payments 

• Lack of transparency into performance 

• Disconnected reporting across quality, risk, utilization, and finance 

The result is predictable. They’re hesitant to take on risk. But what steps can be taken to alleviate their hesitancy? 

• Moving from fragmented reporting to unified, transparent performance visibility 

• Delivering conveniently accessible and frequent, digestible insights (to avoid quarterly surprises) 

• Meeting providers at their level of maturity in their value-based journey
  
  

4) Enablement > Enforcement 

Forcing providers into risk rarely works. But what does? 

• Clear pathways from pay-for-quality → shared savings → risk 

• Peer influence and shared success stories to better drive adoption 

• Understanding the current capability of your providers and not overleveraging them. 

Instead of pushing contracts, facilitate conversations between providers to build belief through real-world success, not mandates.

5) Efficiency Gains Come from Eliminating Duplication 

One of the biggest hidden costs in healthcare is multiple teams managing the same patients independently. This leads to: 

• Double spending 

• Conflicting interventions 

• Poor patient experience 

The opportunity lies in aligning care models across stakeholders, advancing population stratification beyond static risk scores, and delivering real-time, actionable insights at the point of care. In value-based care, efficiency isn’t about doing more—it’s about eliminating what you don’t need. 

6) Simplicity Wins with Physicians 

Physicians don’t engage with complexity—they engage with clarity. This means: 

• Simple financial performance reports 

• Clear comparisons against peers 

• Specific, actionable care gaps 

If a physician can’t quickly understand how they’re performing and what to do next, engagement drops. 

7) Bad Operational Design Will Kill Good Intentions 

Some of the most common failure points: 

• Requiring providers to log into multiple payer portals 

• Changing clinical workflows 

• Creating inconsistent payment models across plans 

Providers already operate in highly fragmented environments. Adding more friction doesn’t drive adoption—it guarantees resistance. 

8) AI Is Starting to Shift the Equation, but When Applied to Operations (Not More Data dashboards)  

AI isn’t just hype. It’s an operational advantage. 

Leveraging AI is key to expanding your capabilities. Successful use cases include: 

• Automating contract performance tracking and reporting 

• Identifying at-risk providers and financial exposure in near real-time 

• Reducing manual effort required for joint operating committee (JOC) reporting 

• Synthesizing dozens of signals into actionable insights 
  
  

The ultimate value of AI isn’t prediction; it’s execution at scale. 

9) The Future Depends on True Plan-Provider Alignment 

Value-based care works only when incentives truly align. This means: 

• Shared infrastructure 

• Shared data 

• Shared accountability 

And critically: 

• A business model that works for both sides 

Without that, even the best technology or contracts won’t succeed. 

Conclusion 

Value-based contracting doesn’t underdeliver because the idea is flawed. It underdelivers when the fundamentals required to drive ROI aren’t in place: 

• The business case isn’t aligned across plans and providers 

• Operations aren’t coordinated to support execution at scale 

• Technology falls short in delivering the transparency needed to build trust 

• Performance issues often aren’t visible until it’s too late to meaningfully course-correct 

What became clear in this discussion is that success isn’t driven by better contracts alone. It’s driven by the ability to operationalize alignment and consistently translate strategy into measurable performance. 

The organizations that will win won’t be the ones with the most contracts. They will be the ones that build the infrastructure, discipline, and visibility required to deliver sustained financial and clinical outcomes at scale.