Health Care Value Week 2025 took place in late February and was packed with insightful discussions. Zach Davis of Wakely and Geoff Matous of Conduce Health reviewed key sessions to explore what they mean for the ACO ecosystem—from both a specialty VBC (Geoff) and an actuarial (Zach) perspective. The series of LinkedIn posts had a ton of engagement from the community—in case you missed it, here they are in a convenient 3-minute read.
Session Review #1: The Past, Present, and Future of Value-Based Care
If the past CMS and CMMI administrators are talking this much about data, we should be too!
Geoff: How Can We Better Incorporate Specialists and Patients?
- “As we simplify the chassis it’s going to let you go longitudinally and episodically (with specialty care risk)” - I look forward to innovative and purpose-built specialty care models from CMMI in the years to come. Today, ACOs can more meaningfully incorporate specialists by combining better incentive alignment with specialists with technology to guide providers and beneficiaries towards personalized high-value specialty care.
- “Even some reimbursement of the savings (to the patient), it would be awesome to get them involved”- Rewarding patient behaviors that lead to better health outcomes is a tremendous opportunity—and maybe one we don’t need to wait for policy to support!. The value-based entity (VBE) protections already allow testing of these types of incentives. I’d also like to see CMS remove cost-sharing for high value services in value-based settings—care management for example…
Zach: What Should Our Data Demands Be in the Future?
- "Fast is better than perfect" - knowing a member had an IP stay 60 days ago is interesting, but knowing a member was discharged today from an inpatient stay is impactable.
- "Data from CMS is better than most data transferred from payers to providers taking risk in MA or commercial contracts." Yes, but we can't compare ourselves to the average and expect to get better. CMS does provide good standardized data, but we need it quicker.
- "ACOs interested in participating should get access to data quicker." The final provider lists are due in September but ACOs starting a new agreement period won't start getting data until February. The ACO starts the second CMS accepts the application not when the performance year starts. Risk coding, patient segmentations, resource allocation can all be done before the performance year starts.
- "Put an AI tool on top of CMS data and open it up to providers and their teams." Each time a new model is released, we learn how a new feature impacts ACOs. This process takes time. If we open source some data (in a secure way!) we can iterate much quicker, and we all learn from it!
Session Review #2: Integrating Specialists with Value-Based Care Delivery
Geoff: How Should Hospital Systems Think About Specialty Value in MSSP ACOs and Beyond?
- “24% of clinicians in an MSSP ACO are PCPs, while 45% are specialists” - Taking this stat in context with the observation of a negative correlation between high mix of specialists and shared savings, it feels like ‘Participating’ and participation can be two very different things. Hospital affiliated ACOs, especially, should take a closer look at how they can connect the right patient to the right specialist at the right time to unlock the value of their specialty care.
- Hospital systems taking steps now to improve specialty care value and performance in existing ACOs will also benefit from early movement on the things required to succeed in the episode-focused TEAM model and AHEAD—the voluntary hospital global budget (HGB) model starting in January 2026.
Zach:
- With the median ACO beneficiary count around 13,500, most ACOs don’t have enough bundled episode volume or administrative capacity to leverage the shadow bundle data. The more promising specialty engagement mechanism is the TEAM model.
- Goal of TEAM = patient focused for better outcomes, quicker recovery, quicker transition back to PCP care, and avoiding ED and re-admissions.
- For some episode bundles, the post-acute cost may only be 20-40% of the total bundle. If there aren't sufficient dollars to save on the post-acute side, this will force hospitals to look internally to create operational efficiency.
- The 5 mandated episodes only account for ~15% of most hospitals’ spend each year, but with a solid evaluation report (CMMI evaluates the performance of each program annually), TEAM could be expanded to more hospitals and more procedures quickly. Hospitals should be watching this model closely.
Session Review #3: ACO Success—Improving Care for Complex Patients
Geoff:
- Michael shared a story reflecting on the above and beyond, but non-medical, interventions that can change the trajectory of a patient’s health outcomes—in this case, fixing a furnace. It was inspiring, and a reminder that organizations focused on serving individuals with complex social and health needs must meet patients where they are in the truest sense.
- I want to have some shiny specialty VBC pearls, but it seems clear that comprehensive in-home primary care and support is the answer for high-needs ACOs. What do you think the most impactful role for specialty care is here?
Zach:
- ACO REACH and MSSP are designed to hit the bulk of the population but there are subsets of the population that these don’t perform well in traditionally designed ACOs. High Needs ACO Reach was a game changer but more work is needed.
Things that went well:
- Concurrent risk scores (better alignment of care to costs)
- Alternative treatment options for a population that has significant needs beyond medical costs
- Data availability drives insights. In a VBC arrangement, providers get all the data and can see the whole patient. This drives insight that providers offering the same services can’t see under FFS arrangements.
Things to add for next model:
- VA alignment in home
- Waiving more cost sharing (the ACO is taking the risk, they should have more flexibility on if and how they get paid)
- Reducing complexity related to benefit enhancement. Some enhancements are so cumbersome, ACO are choosing not to use them.
High Needs ACO REACH has found a way to trade low value high cost services for high touch lower cost services. How can we expand this program and extend considerations to other models?
Health Care Value Week ended but the education, ideas, and inspiration will continue to resonate. Hopefully, those of us in the ACO space leave with fresh perspectives that will shape our approach to value-based care in the coming months.
Check out all the replays here.
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