2025 Year in Review: Data Infrastructure Key to Success in Value-Based Care

This year Healthcare Innovation tracked the shifting landscape in value-based care as the new administration changed the focus at the CMS Innovation Center around a number of alternative payment models but brought continuity in terms of its commitment to value-based care in general and the Medicare Shared Savings Program in particular. 

We also followed trends in how safety net providers are building their data infrastructure to get their feet wet in value-based care and how larger health systems are fine-tuning their analytics to achieve ROI in a variety of commercial, Medicare, and Medicaid contracts. 

In March the CMS Innovation Center announced it would end several alternative payment model programs at the end of 2025, including the Primary Care First and Making Care Primary models as well as the End Stage Renal Disease Treatment Choices model. 

The Innovation Center said the early termination of Primary Care First and Making Care Primary does not signal a retreat from its support of primary care providers, but rather “a need to focus on different approaches that are consistent with the CMS Innovation Center’s statutory mandate and produce savings.” (The Innovation Center has been criticized by some in Congress for not showing enough proof of cost savings from its models.) 

Most models selected for early termination were within two years of their end date. Also ending early was the Maryland Total Cost of Care model, which was planned to run through 2026. Primary Care First was scheduled to run through 2026, and Making Care Primary was scheduled through 2034. ESRD Treatment Choices was supposed to end in 2027.

Following the FQHC movement into value-based care

Traditionally, community health centers have been slow to get involved with value-based care because they lack the data infrastructure and personnel to succeed. But more networks of Federally Qualified Health Centers are forming centralized infrastructure and governance to enable them to participate, and this year we interviewed several of those network leaders. 

For instance, Carina Health Network empowers all of Colorado’s 19 community health centers (CHCs) with data, technology, and strategic support to advance value-based care and improve population health for underserved populations. In 2024 Carina’s member improved care for 11,829 Medicare beneficiaries across Colorado, while also generating $17.6 million in Medicare savings in the Medicare Shared Savings Program.

 In November, Brandi Apodaca, Carina’s chief performance officer, spoke with us about their approach. “I think some of the success was executive buy-in, with leadership believing in the shift to value-based care. Making that a priority took a lot of work at the beginning, in terms of explaining what value-based care is,” she said. “And then we set it up really well. We do a lot of work around practice transformation. Our coaches are all transformation-certified in supporting PDSA-type quality improvement cycles. We meet monthly with each of our community health centers to help hold them accountable in improving on these quality measures, and that has proven successful.”

In another example, Integrated Health Partners (IHP) is a nonprofit, FQHC-controlled clinically integrated network, dedicated to advancing value-based care and payment reform for traditionally underserved populations in San Diego and Riverside counties in California. 

Established in 2015, IHP’s network spans 97 clinical sites and works with six health plans in Southern California. The network supports FQHCs by aggregating data across multiple EHR systems and sources, enabling comprehensive patient views and reducing resource burdens on clinics.

A partnership with health information exchange San Diego Health Connect facilitates real-time data sharing, improving care coordination and patient engagement. IHP actively works with payers to ensure data accuracy, close care gaps, and support the success of value-based payment contracts.

In October Kristine Ortwine, IHP’s director of population health IT and analytics, spoke with Healthcare Innovation about how the FQHCs are leveraging analytics to succeed in value-based care arrangements. 

“IHP is a great example of how you can leverage this support at the network level across those entities that are operating in different geographies with different populations with different resources to push forward with value-based payment,” Ortwine said. “We have two professional risk contracts right now, one with Anthem and one with Blue Shield Promise. That’s a new sort of venture for our health centers, and I think it would have been very difficult for them to start those kinds of relationships and those risk contracts without overarching support, so that's a real win. We have the opportunity to improve care for our patients and manage costs with these alternative value-based care models that might be new to them.”

Ohio-based Muskingum Valley Health Center (MVHC) has been working with public benefit corporation Medical Home Network in CMS’ ACO REACH model. MVHC has created a dedicated value-based care department with 19 R.N. care managers to enhance patient management and outcomes. 

Its partnership with Medical Home Network has helped MVHC expand its value-based care initiatives beyond Medicare to all populations, improving access and reducing costs.
MVHC has 13 locations in four rural counties in eastern Ohio. In a September interview, CEO Dan Atkinson said that for FQHCs, it’s important to have a partner like MHN, “because they bring an element to the table that it's very hard as a health center to duplicate. Whether it's the technology aspect and the risk stratification best practices, and then the ability to take the data that comes in from CMS and put that in a reportable format that's understandable, not only to the business side of things, but also the clinical side of things. They also help with provider engagement. How do you motivate providers to think differently about how they deliver care?”

Atkinson said value-based care is becoming critical to FQHCs’ financial survival. “If we didn't have value-based revenue, we would not be able to continue to do what we do, and expand services and see more patients,” he said. “This partnership has allowed us to springboard our entire program to the next level.”


Building a business case for value-based care

National Association of ACOs (NAACOS) meetings continue to be valuable venues for understanding the shift from volume to value, and this fall, we reported on a NAACOS presentation by Jessica Walradt, vice president of value-based care contracting and performance at Northwestern Medicine. She highlighted some of the challenges involved in building a value-based care return-on-investment business case to present to the C-suite. 

Northwestern Medicine is an 11-hospital health system located in northeastern Illinois with a flagship academic medical center in downtown Chicago. It has more than 2,800 employed physicians and operates two MSSP ACOs, between which it has about 82,000 assigned patients. 

In building a VBC business case, Walradt identified three main buckets of revenue: fee-for-service revenue, incentives from quality measures and downstream shared savings. “The challenges with making a business case with these types of revenue definitely increase as you move down the line, especially with incentives and shared savings,” Walradt said. “They are grounded on really complex financial methodologies, and not only do you need to make sure that your team understands those methodologies, but you have to figure out a way to communicate them to leadership — people who rarely think in terms of a VBC payment model.”

Another issue, she stressed, is that there's often a huge time lag between implementation, scaling and seeing the return on your investment. “It can be one to five years, depending on what the intervention is and how quickly you scale. Convincing your C-suite to invest and be willing to be patient can be pretty challenging.”

Finally, Walradt noted that you’re not making a business case in a vacuum, especially for health systems that are multi-specialty health systems, but whose organization is not just built on an ACO. “Your business case could be really compelling, really robust, but it's being weighed against hiring a new oncologist or expanding clinic space, or investing in a new IT vendor.”

Nebraska Health Network’s approach 

One of the 2025 Excellence Award winners announced at the NAACOS fall meeting was Nebraska Health Network (NHN), the ACO co-founded by two health systems in Nebraska: Methodist Health System and Nebraska  Medicine. Following the conference, Healthcare Innovation spoke with the Omaha-based organization’s CEO, Lee Handke, PharmD, M.B.A., and vice president of value-based care, Mallory Callahan, M.P.A.S., PA-C.

Formed in 2010, Nebraska Health Network has more than 3,600 primary care and specialty physicians and advanced practice providers working throughout the Omaha metropolitan area, Fremont and western Iowa. 

Handke and Callahan explained how Nebraska Health Network manages 14 value-based care agreements across Medicare, Medicaid, and commercial plans, utilizing a centralized data warehouse for quality and cost insights. It has developed a core set of 11 quality measures to streamline reporting.

“Internally, we have a team of population health coordinators who are the experts in different contracts,” Callahan explained. “We have that split out by type of payer, and then all of those lines of business. For example, we have a United Healthcare expert and a Nebraska Medicaid expert, so they know the nuances of that contract language extremely well. They also are monitoring how our quality performance looks. Throughout the year, they are tracking if we could redo this for next year. What are the key contracting pieces that we would want to see change? We also do a lot of forecasting and modeling, looking at previous performance and trying to map out trajectories. I do feel like we've gotten a lot of sophistication in that in the last two or three years.”

The growth of Risant Health

Another development we have been following this year is the growth of Washington, D.C.-based Risant Health, which was created by Kaiser Foundation Hospitals to bring together like-minded health systems to increase access to value-based care. We covered a talk by Jaewon Ryu, M.D., J.D., the CEO of Risant Health, at the annual Population Health Colloquium in Philadelphia about the criteria that the organization is considering as it looks to add more health systems beyond Pennsylvania-based Geisinger and North Carolina-based Cone Health. 


Ryu, who transitioned from the role of CEO at Geisinger to being CEO of Risant, said the organization’s goal is to find five to seven of these systems over the next five to six years or roughly one a year. “They have to be walking the talk on value-based care. I think this is really important. They either have to have their own health plan or a sizable ACO, a lot of downstream risk environments or contracts with other payers,” Ryu said.

He said that if you look at the approximately 700 health systems across the country, he estimates that about 5% to 10% would meet all of its criteria. That means there's probably about 35 to 70 potential health system partners. “Then the question is, who are we a good fit for?”