The contracts are signed. The press release is out. The board is aligned. It’s a meaningful milestone, and yet the real work is just beginning.
Having worked alongside payers on care management and utilization management value-based care (VBC) strategies, one pattern stands out: the organizations making the most progress aren’t necessarily the ones with the most sophisticated contracts. They’re the ones that treated execution as the primary challenge from day one.
The issue rarely lies in the vision. It lies in the gap between signing a contract and transforming a care delivery system. What follows are the most consequential operational gaps we see in years one and two of a VBC strategy — and what leading plans are doing to close them.
Data isn’t a pipeline problem — it’s a workflow problem
Most executives assume that combining claims data with a few clinical feeds is enough to power value-based care. It isn’t. Data arrives delayed, fragmented, and often too inaccurate to drive real-time care decisions. The deeper miss is treating analytics as a reporting function when it needs to be embedded directly into clinical workflows. Retrospective dashboards alone aren’t enough. Providers also need actionable insights at the point of care, when the patient is in front of them.
Leading organizations close this gap by embedding actionable alerts, risk signals, and next-best actions directly into care management workflows and provider-facing tools — so insights are surfaced at the moment decisions are made, not weeks later in reports.
The contract doesn’t change provider behavior
Signing a physician group or health system into a value-based arrangement takes months. Changing how those clinicians actually practice can take years. Fee-for-service habits are deeply embedded, and incentives that seem meaningful at the contract level often aren’t timely or tangible enough to shift daily behavior. Real transformation requires sustained local engagement, redesigned workflows, and the kind of trust that can’t be written into a contract.
Plans that make progress invest early in physician engagement infrastructure — including aligned incentive timing, transparent performance reporting, and dedicated field teams who work alongside providers to redesign workflows in practice, not just on paper.
Care management doesn’t scale the way the models suggest
The classic vision — a centralized care management program identifying high-risk patients and coordinating their care — looks compelling in theory. In practice, high-touch models are expensive, patient engagement rates disappoint projections, and identifying the right patients at the right time remains stubbornly difficult. Care management can be a powerful lever, but only when it’s paired with genuine provider ownership and patient activation. It cannot carry the weight of savings targets on its own.
High-performing programs extend beyond centralized outreach models by enabling shared ownership across care management and provider teams. This means equipping care managers and providers with shared tools and embedded workflows that use risk stratification to identify opportunities for intervention and support action closer to the point of care, rather than relying solely on centralized engagement.
Administrative burden kills adoption before it begins
Value-based care often introduces additional complexity before it delivers simplification. New documentation requirements, coding changes, and reporting obligations are layered on top of existing fee-for-service processes, including prior authorization and utilization management workflows that continue in parallel. The result is operational duplication — and at the point of care, clinicians experience it as double work. That dynamic slows adoption and creates resistance, one of the most underestimated threats to any VBC strategy.
Reducing this friction requires retiring redundant fee-for-service processes, streamlining authorization pathways, and automating documentation wherever possible — not layering VBC requirements on top of existing workflows.
Platforms that are highly configurable and workflow-driven can play a critical role.
The financial timeline is longer — and noisier — than expected
Early results are volatile. Small sample sizes shift. Attribution models change. Coding improvements get mistaken for genuine care improvement. And for chronic disease populations, meaningful outcomes simply take time to materialize. Plans that expect a meaningful return on investment in year one create organizational pressure that’s difficult to manage. The realistic maturation curve is three to five years, and leaders need to build organizational patience for that reality.
Leading plans set expectations upfront with boards and stakeholders, establishing multi-year performance benchmarks and separating signal from noise through consistent attribution and measurement frameworks.
Technology is necessary — but it is not transformation
Investment in platforms and data infrastructure is essential. However, tools don’t change care unless they’re embedded into daily clinical workflows in ways that feel intuitive rather than burdensome. Providers are not waiting for another portal. Interoperability gaps persist. Many organizations underestimate the operational effort required to translate technology into day-to-day workflows. The differentiator is not simply having the right platform, but how effectively it is configured, aligned to real-world processes, and refined over time based on how teams use it. Platforms that are highly configurable and workflow-driven can play a critical role here — allowing organizations to adapt technology to the realities of clinical and administrative work, rather than forcing teams to adapt to the system.
VBC requires an enterprise operating model
Perhaps the most consequential challenge is structural. VBC is not a care management program or a contract model. It is an operating model transformation that touches data infrastructure, clinical workflows, provider incentives, internal alignment, and organizational culture simultaneously. When network, medical management, analytics, and finance teams are pulling in different directions — still influenced by legacy fee-for-service economics — no contract structure can compensate.
This requires formal governance structures that align clinical, network, analytics, and finance teams around shared VBC goals, while also creating tighter alignment with the provider organizations responsible for delivering care. Accountability for outcomes must extend across these boundaries, rather than remaining siloed within functions or between health plan and provider stakeholders. Pilots work, but scaling them exposes every gap in governance and infrastructure that the pilot was too small to reveal. For health plans, these challenges are not external — they are a direct result of how operating models are designed and executed.
VBC doesn’t stall because of the contract. It stalls when operating models don’t change to support it.
Health plan executives who have committed to VBC have already made the strategic decision. The question now is execution. The health plans making measurable progress are the ones that treat the operational work with the same rigor they brought to the strategic one.
From there, the practical issue becomes where to focus first. The organizations succeeding under VBC tend to do a few things early: embed actionable data into workflows, align provider incentives with timely performance feedback, and reduce administrative friction rather than compound it.
VBC doesn’t stall because of the contract. It stalls when operating models don’t change to support it. The plans that succeed are the ones that treat execution as the real work.