AdventHealth

Michael S. Lemell

Value-Based Care Authority

Leadership Lessons in Value-Based Care Contracting

Value-based care contracting has taught me that leadership is less about having the loudest opinion in the room and more about creating alignment across groups that often measure success differently.

Finance, operations, physicians, payers, analytics, and managed care teams may all be looking at the same agreement through different lenses. The work requires discipline, patience, and a willingness to translate complexity into decisions people can act on.

It has also reinforced that good contracting is not just about negotiating terms. It is about building models that can actually be operationalized. A contract may look strong on paper, but if the care teams, data infrastructure, reporting cadence and financial incentives are not aligned, the model will struggle.

My leadership approach has subsequently become quite practical—define the goal, understand the risk, pressure-test the assumptions and make sure the strategy can survive contact with reality.

Transitioning to Value-Based Care Models

One of the biggest challenges is moving from a volume-based mindset to a performance-based operating model. That sounds simple in concept, but it affects nearly everything. It impacts how organizations measure success, how physicians are supported, how data is used, how risk is evaluated and how leaders make investment decisions.

Another challenge is data. Value-based care depends on timely, accurate, and actionable information. Without that, organizations are often trying to manage performance by looking in the rearview mirror.

There is also the challenge of balancing ambition with readiness. Many organizations want to move quickly into value-based arrangements, but the operational capabilities have to match the financial risk being accepted. Otherwise, the organization can end up taking on downside exposure before it has the tools to manage it effectively.

Balancing Financial Sustainability with Improving Patient Outcomes

The best contract strategies do not treat financial sustainability and patient outcomes as competing goals. They should reinforce each other. A well-designed value-based arrangement creates incentives to reduce avoidable utilization, improve access, close care gaps, coordinate care more effectively and support better outcomes.

That said, the balance has to be intentional. Contract terms need to be realistic, measurable, and tied to areas where the provider organization can actually influence performance.

Financial sustainability also requires understanding the population, the risk adjustment methodology, quality measures, attribution rules, payment timing and operational cost structure. In simple terms, the math and the care model have to work. If either one is missing, the strategy is not sustainable.

The Future of Value-Based Care and Healthcare Reimbursement

A few trends stand out.

First, there is continued movement toward accountability for the total cost of care, quality and patient experience.

Second, data and analytics are becoming more central, particularly around risk stratification, performance monitoring and identifying opportunities for intervention earlier.

Third, organizations are becoming more thoughtful about risk. The future is not simply “take more risk”; it is taking the right risk, with the right partners, for the right populations, supported by the right infrastructure.

I also think partnerships will matter more. Health systems, payers, physicians, employers and technology partners all have a role to play.

The organizations that succeed will be the ones that can connect strategy to execution without losing sight of the patient in the middle of all the spreadsheets. And there are always spreadsheets.

Building a Career in Value-Based Care and Healthcare Strategy

My advice would be to build range. Value-based care sits at the intersection of healthcare finance, clinical operations, managed care, law, data analytics, and strategy. You do not need to be the deepest expert in every one of those areas, but you do need to understand how they connect.

I would also encourage people to stay curious and avoid becoming too theoretical. The best strategies are grounded in how healthcare actually operates. Spend time understanding physicians, operators, patients, payers and the people responsible for turning strategy into daily execution.

Finally, learn how to communicate clearly. In this field, complexity is unavoidable, but confusion is optional. The ability to make a complicated issue understandable is one of the most valuable skills a healthcare leader can develop.