Crucial Conversation: Value-based Care Partnerships
The Nashville Health Care Council’s November 8th Crucial Conversations event provided a timely exploration of value-based care (VBC) partnerships in healthcare. The conversation, led by Daniel Patten, Partner, Holland & Knight LLP, featured a panel of VBC experts including Janelle Gingold, Director at ATI Advisory, Ross Lagerblade, Vice President of Value-Based Strategies at Humana, and Beth Van Gilder, Chief Operating Officer, Ascension Saint Thomas Medical Partners.
The candid discussion examined the state of VBC, reflecting both meaningful progress and enduring challenges, and explored how providers, payers, and policymakers can better align around outcomes, quality, and cost in a changing health care landscape.
Value-Based Care Is No Longer a Pilot, but a Structural Shift
Panelists agreed that VBC has evolved from a series of pilot programs into a core framework for the future of health care delivery. Moderator Patten stated more than half of traditional Medicare beneficiaries now participate in an accountable care model, and the federal government has set a goal for near-universal adoption by 2030.
Gingold, who previously served at the CMS Innovation Center, confirmed that this push is real and accelerating. They’re increasing the speed with which participants are expected to take on risk, especially two-sided risk, she explained. We’re already seeing that, and this administration has made it clear they’re much more focused on savings than previous ones.
She added that it is sort of an inflection point for specialty care, noting that CMS is now exploring models that bring specialists more directly into risk-bearing arrangements and acknowledging that more mandatory participation of these models may be on the horizon.
Alignment is Essential
Lagerblade described the ongoing challenge of aligning payers, providers, and patients around shared goals. “At the end of the day,” he said, “you have really three people involved in care—your patient, your provider, your payer. How do we align all three of those?”
From the health system lens, Van Gilder shared that her medical group participates in nearly every kind of value-based arrangement—traditional Medicare ACOs, Medicare Advantage, commercial programs, and managed Medicaid. But even with that breadth, alignment isn’t easy. “Sometimes my incentives in the medical group don’t align with my hospital president’s,” she admitted.
However, she said Ascension’s mission-driven approach helps bridge the gap: “Our priority is the vulnerable population. That aligns with the health system’s incentives,” bringing the two groups back together.
Administrative Complexity and Financial Lag Remain Major Barriers
There was consensus across the panel that administrative costs and lagging reimbursement are major barriers to success. Patten noted that often “15 to 30% of the shared savings is going to go to just standing up these systems. You need the money in the pocket to begin with.” He highlighted how the timing of shared savings, which arrive many months after care has been provided, complicates the operations of a value-based care model.
Van Gilder shared how the complexity of administering value-based programs impacts her clinicians directly. “The biggest burden we have is checking the boxes,” work that is above and beyond delivering high-quality care to make sure reporting happens in a way that registers with VBC programs. Add to the high volume of reporting and lack of interoperability the burden of prior authorization, and physicians’ frustration is easy to understand. She emphasized that burnout is a barrier to value-based care itself: “We’re asking our physicians to take on more tracking, more coordination, more management. They just want to take care of patients.”
Lagerblade added that the industry’s fragmented data and inconsistent governance make it even harder to sustain progress. Despite widespread adoption of value-based programs, many physicians remain unaware of how their performance is being measured or how contracts affect patient care. He pointed out that even within large, integrated organizations, variability in care delivery remains high, and the lack of seamless data exchange prevents teams from identifying best practices. Building trust and ensuring that physicians see clear, consistent information about their patients and performance, he said, is essential for meaningful change.
Success Depends on Trust, Transparency, and Measurable Outcomes
Van Gilder shared tangible progress from Ascension Saint Thomas’s efforts to redesign care teams. When she arrived eight years ago, the organization had just hired its first ambulatory pharmacist. The organization now employs 8-9 ambulatory pharmacists whose roles “take an enormous load off physicians” and help manage chronic care more effectively.
She also described success with community health workers supported by a Tennessee Department of Health grant, emphasizing their impact on social determinants of health. One story stood out: “A patient showed up in the ER twice in one day,” she recalled. “When our care manager called to ask why, she said, ‘I got home and didn’t have any food, and you guys have the best cheeseburgers.’” Van Gilder said these moments illustrate the need to address food insecurity as part of the care equation: “If we can make sure Mrs. Smith has groceries delivered, she’s not back in the ER eating a $5,000 cheeseburger.”
Gingold connected these local innovations to the broader federal direction. She noted that CMS is increasingly focused on refining existing programs and creating data systems that make care more proactive rather than reactive. “It’s less about launching new models,” she said, “and more about improving the models we already have by integrating data, evaluating performance faster, and expanding successful approaches into new specialties.”
Lagerblade echoed that innovation can’t just come from technology, it must come from relationships. “We have to do this with providers, not to providers,” he said. “This is a marathon, not a sprint. Trust comes first.”
Closing Remarks
The panelists agreed that the path forward for VBC requires sustained collaboration, realistic timelines, and a renewed focus on outcomes that matter most to patients. The conversation highlighted priorities for the next phase of transformation, including building trust between payers and providers through data transparency, reducing administrative burden for care teams, expanding specialty care participation, and investing in infrastructure and workforce to sustain innovation and operational efficiency.
Each leader emphasized that, while financial models and federal mandates will continue to evolve, the ultimate measure of success lies in improving lives, not just lowering costs. Value-based care is a long-term commitment to partnership and adaptability.
Thank you to our sponsors: Holland & Knight and Oracle Health & Life Sciences
About the Nashville Health Care Council
The Nashville Health Care Council strengthens and elevates Nashville as The Healthcare City. With a $68 billion economic impact and 333,000 jobs locally, Nashville’s healthcare ecosystem is a world-class healthcare hub. Founded in 1995, the Council serves as the common ground for the city’s vibrant healthcare cluster. The Council offers engagement opportunities where the industry’s most influential executives come together to exchange ideas, share solutions, build businesses and grow leaders.
