Dec 12, 2025
Kris Kang, VP, Access Experience Team
Value-based and risk-sharing reimbursement models are gaining traction within Medicare — but what about the commercial market? Increasingly, these arrangements are also taking hold among health systems, provider groups, and commercial payers.
From Upside-Only to Two-Sided Risk
Research on accountable care organizations (ACOs) shows that many providers now participate in value-based reimbursement models not only with Medicare plans and Medicaid managed care organizations, but also with commercial insurers. Additionally, one of the most notable shifts has been the shift from upside-only contracts (shared savings) to arrangements that incorporate downside or double-sided risk, where health systems and provider groups take on both potential savings and potential losses for their organizations.
Survey data shows that many health systems are now willing to absorb losses if spending exceeds targets — an indication of rising confidence in their ability to manage population health and leverage data and analytics.
Expanding Risk Models Across Lines of Business
Health systems and providers are not only deepening their participation in risk-based arrangements but are also diversifying the types of risk they take on. CFOs and managed-care leaders report increased interest in capitation models — professional, partial, and global — across commercial, Medicare, and Medicaid lines of business.
Why Payers are Driving the Shift
For payers, this shift is driven by a desire to move away from traditional fee-for-service reimbursement, which can often encourage overutilization of healthcare services, leading to unnecessary financial burden, and toward models that reward value, quality, and optimization rather than volume. Under risk-sharing frameworks, providers and health systems are compensated based on performance, incentivizing high-quality, cost-effective care.
Overcoming Data and Infrastructure Challenges
Despite significant challenges with data capabilities, including real-time claims information, strong analytics, and robust population health management strategies, many health systems are investing heavily in population health management infrastructure, including AI, care management teams, and data-sharing frameworks to support these models.
The Future of Value-Driven Care
Should we expect continued growth and alignment in this space? Yes. For payers, this helps lower their financial risk, and their confidence in this space increases as they look to leverage or mimic Medicare and Medicaid value-based reimbursement models. For providers and health systems, taking on risk offers opportunities to secure predictable revenue streams and build more resilient operations.
While the transition can be complex — demanding a change in care delivery models, technology investments, and careful financial management — organizations that succeed are often better positioned for the future of value-driven healthcare.
In short, risk-sharing or value-based contracts are no longer experimental; they are becoming a mainstream mechanism for collaboration and financially incentivize alignment between health systems, provider groups, and payers. The healthcare landscape is steadily moving toward more sophisticated, two-sided risk models, supported by stronger data infrastructure and better management of healthcare resources.
As health systems, provider groups, and payers continue to invest in value-based care, the shift toward risk-based contracting is likely to accelerate, reshaping the financial and care-delivery framework and infrastructure of U.S. healthcare.
As part of the healthcare ecosystem, pharma should monitor the impact of this trend and recognize the importance of incorporating value messages through the lens of value-based care. In addition, pharma can employ a transformational strategy to seek opportunities for partnership with these stakeholders in risk-sharing, value-based arrangements.