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:
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.
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.
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
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.
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.
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.
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.
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.
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.
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.