Why Value-Based Care Programs Fail to Scale: Operational and Data Architecture Barriers

Authors: Sushrut Naik

DOI: https://doi.org/10.37082/IJIRMPS.v14.i2.233169

Short DOI: https://doi.org/hb8w43

Country: United States

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Abstract: Value-based care (VBC) has been considered as a primary solution to manage the ever-unsustainable U.S. healthcare costs. Even then, most VBC programs have failed to achieve meaningful savings or clinical quality improvements at scale. This paper examines three systemic barriers to development and scalability of VBC: 1) patient attribution challenges, 2) fragmented risk adjustment data pipelines, and 3) operational execution failures. In this paper we are sharing our insights on the above-mentioned systemic barriers by leveraging CMS evaluations, industry surveys, and peer-reviewed research. Healthcare organizations manage an average of 18.3 distinct clinical systems, of which only 26.2% are effectively interoperable. Meanwhile, fewer than one in four CMMI models have produced net cost savings. VBC will remain aspirational until the industry resolves foundational data architecture and operational coordination problems. The paper concludes with strategic recommendations for bridging the gap between VBC promise and performance.

Keywords: Value-Based Care; Patient Attribution; Risk Adjustment; Hierarchical Condition Categories (HCC); Data Interoperability; Healthcare Data Architecture; Operational Scalability; Medicare Advantage; Accountable Care Organizations; Care Coordination

Paper Id: 233169

Published On: 2026-04-04

Published In: Volume 14, Issue 2, March-April 2026

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