As health systems approach another round of the Center for Medicare and Medicaid Innovation (CMMI) program milestones, one reality is clear: Value-based care (VBC) has fundamentally changed. Years of margin pressure and market volatility have driven many systems to step back from risk sharing with payers to stabilize their balance sheets. 

Yet this retrenchment is temporary, at best. The structural forces reshaping health system reimbursement - shifting payer mix, unit rate pressure, and regulatory momentum toward alternative payment models, remain firmly in place. What has changed is the rules of engagement: capital is scarcer, talent tighter, and risk models more complex. At the same time, expectations have risen, VBC must move beyond closing care gaps and documenting risk to deliver lower total cost and a more predictable trend. It is no longer optional; it is a core operating discipline.

Health system leadership teams face a stark choice: reviving VBC with focus, rigor, and courage, or risk long-term irrelevance in a reimbursement system increasingly dominated by governmental purchasers.

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