The Eight Pillars of a Value-Based Organization — And Why Most Systems Are Missing At Least One.
Before you can honestly assess your chances of success in value-based care, there are eight foundational pillars worth examining in your organization. Most health systems have some of these in place. Very few have all of them aligned — and the gap between having them and having them working together is where most value-based programs quietly fail.
01 Governance and Clinician Leadership
Do you have true clinician leadership guiding your value-based programs? And clinician broadly — this isn't just physicians and providers. Nursing must have a seat at the table as well. The right governance structure ensures that the programs you're entering actually align with your organization's real clinical capacity.
The ACO REACH Model requires that participating providers or their appointees control 75% of the ACO's governing body — a significant increase over the 25% requirement under the prior GPDC model. CMMI designed that requirement specifically to ensure that doctors and other healthcare providers play a primary role in accountable care. If CMS is mandating provider-led governance at that level in its own models, your internal governance should reflect the same priority.
Research confirms that strong leadership is one of the primary facilitators of value-based healthcare implementation — while resistance to change remains one of the most significant barriers. The two are often the same problem viewed from different angles.
02 A Financially Fluent Team
Do you have a financial team that genuinely understands the difference between fee-for-service historical payments and how to leverage a value-based portfolio? These are fundamentally different models, and the people managing your finances need to understand both. The analytical frameworks, forecasting assumptions, and variance tolerances that work in one world can actively mislead you in the other.
03 Aligned Contracting and Payer Relations
Do you have a contracting and payer relations team that understands how the fee-for-service and value-based worlds coexist — and who also has either the clinical knowledge or the curiosity to dig into the measures being required and align around them? This bridge between business and clinical is often overlooked. Its absence quietly undermines even the best-designed programs, because contracts get signed without the clinical infrastructure to perform against them.
04 A Data-Ready IT Team
Do you have an IT team that understands data aggregation and has already made meaningful progress on pulling that information together — both on the back end for analysis, and on the front end for clinical teams who need it at the point of care? Streamlined data access empowers providers to better manage patient populations, identify cost-saving opportunities, and implement timely interventions. Without it, even the best care management strategy operates blind.
05 The Right Kind of Analytics
Value-based analytics are built around utilization patterns from the patient's perspective, and on outcomes that span across departments rather than being siloed within a single service line. Strong general reporting capabilities don't automatically translate — and organizations that assume their existing analytics infrastructure is sufficient for value-based performance management frequently discover the gap at the worst possible moment.
06 Patient Engagement and Social Determinants of Health
This is a significant gap in many organizations' value-based strategies. Addressing social determinants of health — housing, transportation, food security — can significantly impact a patient's ability to follow through on their care plans.
A Deloitte survey found that 88% of hospitals screen patients for social needs — but only 33% have a well-defined process for connecting patients with the appropriate resources. You can close every quality gap on paper and still fail if your patients can't follow through on the other side of the appointment.
07 Population Health Infrastructure
Value-based care requires the ability to identify and stratify your highest-risk patients before they become expensive. This is distinct from general analytics — it requires proactive outreach workflows, care management teams, and embedded processes that most fee-for-service organizations have never needed to build. Building them after entering downside risk is possible. It is significantly more expensive than building them before.
08 Change Management and Culture
The hardest one to put on an org chart. The shift to value-based care demands a cultural change — prioritizing patient outcomes over service volume, and restructuring the workflows, incentives, and expectations that have organized clinical work for decades. Without intentional change management, even organizations with the right teams and technology will stall.
A bad system will beat a good person every time. Change management is how you make sure the system is on the same side as your people.
Getting these eight pillars right won't guarantee success in value-based care. But lacking any one of them will make it significantly harder — and lacking several of them without knowing it is the most common reason organizations stall after a promising start.
The more common challenge isn't that a single pillar is missing. It's that several are misaligned with each other — a financially sophisticated team operating without clinical buy-in, or a strong IT infrastructure with no analytics strategy to leverage it.
In those situations, the most important thing you can source isn't a tool or a software platform. It's real, on-the-ground experience from people who have actually sat in these seats — and who understand what it takes to get these domains working together, not just individually.
[1] Health Catalyst. Navigating Value-Based Care in 2025: Three Challenges Ahead. healthcatalyst.com
[2] MedInsight. Navigating Value-Based Care in 2025. medinsight.com
[3] Khalil H, et al. Implementing value-based healthcare: a scoping review. Frontiers in Public Health, 2025.
[4] Ropes & Gray. REACH-ing for Something New: CMMI DCE Model to Be Replaced by New ACO Model. 2022.
[5] American Hospital Association. CMMI Announces Transition of Direct Contracting Model into New ACO REACH Model. 2022.
[6] Deloitte. Social Determinants of Health Survey. deloitte.com
[7] Pinnacle Healthcare Consulting. Where Healthcare is Going in 2025 and Beyond.
[8] Innovista Health. Keep Value-Based Care Momentum Going in 2025.
If more than one of these pillars sounds familiar — or if you have the pieces but they aren't working together — Adverus Value Strategies brings direct experience building and aligning these very domains in practice, not just in theory.
