Healthcare is at a crossroads. With rising costs, an aging population, and persistent margin pressure, health systems are under increasing scrutiny and strain. Yet amid these headwinds, a powerful shift is taking place: the move to value-based care.
In a recent webinar moderated by Geoff Matous, President and Chief Growth Officer at Conduce Health, leaders across the healthcare spectrum came together to tackle the realities, challenges, and opportunities of this shift. The panel included:
- Karen Joswick, President & CEO of Benevolence Health
- Dr. Najib Jai, Co-founder & CEO of Conduce Health
- Zach Davis, Senior Consulting Actuary at Wakely Consulting Group
Here are some of the most important insights from the discussion, and what they mean for health systems navigating the path to value.
The Case for Change: It’s Not Optional Anymore
Healthcare leaders are increasingly facing a hard truth: fee-for-service models are financially and operationally unsustainable in the long term. As Geoff Matous noted, quoting Paul Kusserow’s recent book The Coming Healthcare Revolution, “Payment for outcomes, not procedures, is the only sustainable path forward.”
This isn't just a philosophical shift, it’s a survival strategy. Between Medicare insolvency risks, workforce shortages, and inflationary pressures on the costs to deliver health care, holding on to the status-quo is no longer viable.
Why Health Systems Are Positioned to Lead—But Need to Act
Dr. Jai brought optimism to the conversation. He framed health systems as uniquely positioned to succeed in value-based care due to three core strengths:
- Technology infrastructure (often built around a single EMR),
- Operational alignment, and
- System-wide behavior change potential, from executives down to care teams.
But to realize this potential, Jai emphasized that systems must make strategic investments, and not just in tech. “It’s about strategic focus,” he said. “That cultural shift has to happen.”
The Reality Check: Financial and Operational Barriers
While the vision is clear, the road is rocky. Karen Joswick struck a more cautious tone. “The financial vulnerability is real,” she warned. From children’s hospitals to rural health systems, many organizations are in survival mode, making large-scale transformation feel out of reach.
She also called out three significant gaps:
- Data and analytics: Many systems don’t know how they’re performing in value-based contracts.
- Workforce and training: There’s a shortage of trained staff who understand population health and post-acute coordination.
- Infrastructure: Many still lack the tools to make informed, proactive care decisions.
Making the Math Work: Aligning Incentives
Zach Davis underscored the need to build payer-provider trust and ensure contracts reflect shared goals and risk tolerance. “If you don’t know your gain/loss position every month, you’re not ready for risk,” he said.
He also noted that CMS policy changes point to a growing expectation: risk-bearing entities—particularly those involved in specialty care—must step up. Programs like the TEAM model and new mandatory bundles signal where things are headed.
So, What Can Systems Do Now?
The panel offered tactical advice for leaders looking to take action:
- Set your risk appetite: Understand what your system can absorb and build from there.
- Invest in data visibility: Know your performance in real-time, not just quarterly or annually.
- Build cultural alignment: Value-based care must be a system-wide priority, not a side project.
- Train and elevate teams: Equip care teams with the knowledge to manage populations and interpret data.
Joswick emphasized the need for change leadership: “This is operationalizing change management. It has to be woven into the fabric of your organization.”
AI and Technology: A Tool, Not a Savior
When it comes to AI, the panel agreed it holds promise—but also risk. Tools like ambient scribes and predictive analytics can improve efficiency, but without the right workflows, leadership buy-in, and integration, they risk becoming “just another piece of technical debt.”
Dr. Jai pointed out that AI can be a lever for reducing initial investment burdens, key to making the value-based transition financially viable.
The Bottom Line: The Dollars Have to Matter
Whether systems are dipping a toe or diving into the deep end of value-based care, they need models where the financial upside is meaningful. “Until the dollars are big enough, they’re rounding errors,” Joswick said. The good news? That threshold is within reach, especially with CMS nudging providers further into risk.
Final Thought
To succeed in value-based care, health systems need more than new contracts—they need a new mindset. One that blends clinical excellence with data fluency, system-wide coordination, and a commitment to changing how care is delivered.
Watch the full webinar here: Accelerating the Transition Strategies for Health Systems to Thrive in Value Based Care (5/2/2025)
