Value-based care is supposed to be the future of healthcare. Instead of paying doctors and hospitals based on how many procedures they do, the idea is to pay based on patient outcomes. In theory, that should lower costs, improve care, and fix some of the worst incentives in the system.
But in reality, the rollout has been uneven. According to a McKinsey report, some specialties have embraced the shift. Others are dragging their feet—or are stuck in a system that still favors volume over value.
Primary Care: The Backbone of Value-Based Care
Primary care has taken the lead in value-based care adoption. That makes sense. Primary care physicians (PCPs) are often the first point of contact for patients and the ones coordinating care. When they do their jobs well—catching problems early, managing chronic conditions, and reducing hospital visits—healthcare costs go down.
This is why Medicare, Medicaid, and private payers have pushed primary care into models like ACO REACH, Primary Care First, and MSSP. These programs let doctors share in the savings if they improve patient health while keeping costs down.
Take the example of ChenMed, a primary care group that serves Medicare Advantage patients. They take greater risk for their patients’ healthcare costs, meaning they make money by keeping patients healthy and out of the hospital.
They do things like provide transportation to appointments and assign personal doctors to each patient. It works for them—patients experience 50% fewer hospitalizations and 35% fewer emergency room visits.
But here’s the problem: primary care doesn’t control everything. A PCP can recommend a healthier diet or prescribe medication, but they can’t force a patient to follow through. And when a patient needs surgery or specialized treatment, the PCP has little control over what happens next. That’s where other specialties need to step up.
Nephrology and Oncology: The Specialists Leading the Pack
Nephrology has become one of the fastest-growing specialties in value-based care. This is largely driven by Medicare’s focus on chronic kidney disease and end-stage renal disease (ESRD), which are extremely expensive to treat.
Kidney care groups are now entering risk-based contracts that reward them for slowing disease progression and reducing the need for dialysis. Companies like Strive Health are building entire care models around this, using predictive analytics to flag high-risk patients and intervene before they end up in the hospital.
Oncology is also starting to shift, though more cautiously. Cancer treatment is expensive, and oncologists have historically made money by prescribing high-cost drugs.
But payers are starting to push back, offering oncologists financial incentives to prescribe more cost-effective treatments while improving patient outcomes. Programs like the Oncology Care Model (OCM) have encouraged doctors to follow evidence-based guidelines and coordinate care better.
But this only works if the math makes sense. If doctors take on too much risk and lose money, they’ll walk away from these programs. That’s why some oncologists are hesitant—no one wants to be penalized for factors they can’t control, like a patient’s response to treatment.
Orthopedics and Women’s Health: Moving in the Right Direction
Orthopedic surgeons perform some of the highest-cost procedures in medicine, like joint replacements. Because of this, employers and insurers have started pushing for bundled payments, where hospitals get a fixed amount for a procedure and must manage costs within that budget.
If they can prevent complications and unnecessary rehab visits, they keep more of the money. The Comprehensive Care for Joint Replacement (CJR) model has helped accelerate this, and some orthopedic groups are now fully embracing episode-based payment models.
Women’s health has also started shifting, but mainly in Medicaid. States like Tennessee and Ohio have launched maternity episode-based payment models that encourage better prenatal and postpartum care.
But in the commercial market, it’s still slow going. Employers and insurers haven’t fully embraced the idea, and many OB-GYN practices still operate in a traditional fee-for-service model.
Cardiovascular and Behavioral Health: Still Lagging
Cardiovascular disease is one of the most expensive conditions in the healthcare system. But despite that, value-based care adoption has been slow. The main reason is that cardiologists deal with high-risk, complex patients who often require urgent care.
It’s difficult to create payment models that fairly compensate doctors while holding them accountable for long-term patient outcomes. Some hospitals have experimented with bundled payments for procedures like heart bypass surgery, but the shift has been gradual.
Behavioral health is even further behind. Mental health providers often aren’t integrated into the broader healthcare system, making it hard to track outcomes.
Many behavioral health conditions require ongoing treatment, and defining what success looks like isn’t always straightforward. While some providers are experimenting with value-based contracts, most payments are still based on the number of visits, not the quality of care.
Table: Value-based care adoption across different specialties
| Specialty | Adoption Level | Why It Works (or Doesn’t) | Example Program |
| Primary Care | High | PCPs coordinate patient care, manage chronic diseases, and prevent hospitalizations. Clear financial incentives under ACO models. | MSSP, ACO REACH, Primary Care First |
| Nephrology | High | Medicare focus on reducing CKD/ESRD costs. Providers rewarded for delaying disease progression. | Kidney Care Choices (KCC), ESRD Treatment Choices |
| Oncology | Moderate | Incentives for prescribing cost-effective drugs and coordinating care, but oncologists fear financial risk. | Oncology Care Model (OCM) |
| Orthopedics | Moderate | Bundled payments for joint replacements help reduce complications and streamline costs. | Comprehensive Care for Joint Replacement (CJR) |
| Women’s Health | Moderate | Medicaid-led initiatives for maternity care, but commercial adoption is slow. | Maternity Bundles (Medicaid-focused) |
| Cardiovascular | Low | High patient complexity, acute events make long-term cost reduction difficult. Some movement in bundled payments. | Bundled Payments for Care Improvement (BPCI) |
| Behavioral Health | Low | Poor integration with medical care, lack of clear outcome measures. Payments still largely visit-based. | Limited adoption of value-based contracts |
What’s Next for Value-Based Care?
The specialties that have embraced value-based care the most—primary care, nephrology, and oncology—share a few things in common. They have clear cost-saving opportunities, well-defined patient populations, and financial incentives that reward better management of chronic conditions.
Specialties like orthopedics and women’s health are moving in that direction, but they still have a way to go. Cardiology and behavioral health remain stuck in the old system, either because of high patient complexity or a lack of standard outcome measures.
For value-based care to work across all specialties, two things need to happen. First, payers need to design better incentives that encourage specialists to take on financial risk without penalizing them unfairly.
Second, healthcare organizations need to invest in care coordination, data sharing, and patient engagement tools that make it easier to track outcomes and close gaps in care.
We’re not there yet, but the shift is happening. The question is whether the industry can move fast enough to make a real impact before the old fee-for-service model pulls everyone back in.
Get in Touch
If you’re navigating the shift to value-based care—whether you’re a provider, payer, or digital health company—figuring out how to structure contracts, align incentives, and drive adoption can be a challenge.
I help healthcare organizations cut through the noise and build practical, financially viable value-based care strategies. From identifying the right payment models to ensuring specialists are positioned for success, I focus on real-world execution, not just theory.
If you’re looking to accelerate adoption, optimize revenue, or make VBC work for your business, let’s talk. Write to me at astrunk@accretiveedge.com.
Disclaimer: This information is accurate at the time of publishing. We recognize there are significant changes afoot, and we’ll be monitoring the situation and keeping information current as news breaks.
