The healthcare industry’s transition toward value-based care has long been framed through the lens of reimbursement reform, but Lakshmi Halasyamani, M.D., Chief Clinical Officer at Endeavor Health, argues that this perspective is fundamentally flawed. Speaking on the current state of the industry, Halasyamani emphasized that value-based care (VBC) has become one of the most misunderstood terms in modern medicine, often reduced to a series of complex contractual arrangements between payers and providers. For Endeavor Health, a leading integrated delivery network in the Chicagoland area, the shift toward value is viewed not as a financial maneuver, but as a core clinical promise to the populations they serve.
According to Halasyamani, the traditional hospital approach—treating VBC as a secondary payment stream—prevents health systems from achieving the true potential of the model. She advocates for a total evolution in how health systems perceive their role, moving away from transactional relationships and toward a holistic understanding of the patient. This requires a deep dive into both clinical data and the socio-economic realities of patient lives, merging these insights to create a healthcare ecosystem that prioritizes long-term outcomes over short-term volume.
The Evolution of Value-Based Care and the 2030 Mandate
The urgency of this shift is underscored by the aggressive targets set by the Centers for Medicare & Medicaid Services (CMS). In 2021, the CMS Innovation Center (CMMI) announced a strategic goal to have 100% of original Medicare beneficiaries and the vast majority of Medicaid beneficiaries in accountable care relationships by 2030. This mandate represents a massive departure from the fee-for-service (FFS) model that has dominated American healthcare for decades.
The chronology of this transition began in earnest with the passage of the Affordable Care Act (ACA) in 2010, which established the Medicare Shared Savings Program (MSSP). Over the last 14 years, the industry has seen a proliferation of models, including Next Generation ACOs, Bundled Payments for Care Improvement (BPCI), and the more recent ACO REACH model. However, despite these efforts, a significant portion of the provider landscape remains entrenched in FFS, where revenue is tied to the volume of tests and procedures rather than the health of the patient.
Halasyamani noted that while the current leadership at CMS has not recently issued a high-profile reaffirmation of the 2030 target, the direction of the market remains clear. For Endeavor Health—the entity formed by the 2022 merger of NorthShore University HealthSystem and Edward-Elmhurst Health—the demographic reality of their service area makes the transition unavoidable. The system serves a patient base that is aging rapidly, requiring coordinated, longitudinal care to manage chronic conditions like diabetes, heart failure, and COPD. These are the exact patient profiles that benefit most from value-based arrangements, which incentivize preventative care and the reduction of unnecessary hospital readmissions.
Moving Beyond Silos: The Endeavor Health Strategy
A common pitfall for large health systems is the creation of a "Value-Based Care Division" that operates independently of the main clinical enterprise. Halasyamani explained that Endeavor Health has intentionally avoided this "silo" approach. Instead, the system has integrated value-based initiatives directly into its existing quality and efficiency frameworks.
By folding this work into the standard operating procedure of the health system, Endeavor aims to apply the "value lens" to every patient, regardless of whether they are enrolled in a specific Medicare Advantage plan or a commercial ACO. This strategy is rooted in the belief that clinical excellence and affordability should not be mutually exclusive. If a care pathway is efficient and high-quality for a value-based patient, it should logically be the standard of care for a fee-for-service patient as well.
The integration strategy also addresses the "double bucket" problem, a common challenge where providers must manage two different sets of incentives simultaneously. By standardizing high-value clinical protocols across the board, Endeavor reduces the cognitive load on physicians and ensures that the system’s infrastructure—from IT to pharmacy—supports a unified goal of patient wellness.
Supporting Data: The Impact of Social Determinants and Affordability
Central to Halasyamani’s vision is the inclusion of data that typically falls outside the traditional electronic health record (EHR). Research consistently shows that clinical care accounts for only about 20% of a patient’s health outcomes, while the remaining 80% is driven by social determinants of health (SDoH), such as housing stability, food security, and financial constraints.
Halasyamani highlighted the issue of medication adherence as a prime example of the intersection between clinical care and affordability. "If I prescribe a medicine that’s $200 a month, is that going to even be filled? And if not, what are my other options?" she asked. This question is backed by staggering industry data: according to a report from the Annals of Internal Medicine, non-adherence to prescribed medications causes approximately 125,000 deaths and at least 10% of hospitalizations annually, costing the U.S. healthcare system between $100 billion and $300 billion each year.
To address these gaps, Endeavor Health is looking at broader environmental factors. For instance, if a physician advises a patient to exercise more, but that patient lives in a neighborhood where it is unsafe to walk outside during their available hours, the clinical advice is essentially moot. By investing in data and community relationships that provide insight into these "outside-the-exam-room" factors, health systems can tailor care plans that are actually feasible for the patient to follow.
Official Responses and Industry Reactions
The perspective shared by Halasyamani reflects a growing sentiment among clinical leaders across the United States. Groups like the National Association of ACOs (NAACOS) have long advocated for more "human-centric" metrics in value-based contracts. While financial benchmarks remain the primary way success is measured by payers, clinical leaders are increasingly pushing for the inclusion of patient-reported outcome measures (PROMs) and health equity benchmarks.
However, the transition is not without its critics and skeptics. Some healthcare economists point out that the financial risk associated with value-based care can be prohibitive for smaller, independent practices or systems with thin margins. The "downside risk" models, where providers must pay back money if they exceed spending targets, have seen slower adoption than "upside-only" models.
Industry analysts suggest that for Halasyamani’s vision to become the industry standard, there must be a significant improvement in data interoperability. Currently, many providers struggle to get real-time claims data from insurers, making it difficult to track a patient’s journey through the healthcare system if they receive care outside of their primary network. Without a "360-degree view" of the patient, the promise of coordinated, longitudinal care remains difficult to fulfill.
Broader Implications and the Path Forward
The shift toward viewing value-based care as a "promise to the people" rather than a contract has profound implications for the future of the healthcare workforce. Physician burnout has reached record highs, often driven by the administrative burden of documenting for billing purposes rather than patient care. By reframing the goal toward clinical value and patient life-fit, health systems may find a way to re-engage clinicians in the mission of medicine.
Furthermore, this approach necessitates a change in how health systems invest their capital. Instead of focusing solely on new hospital towers or high-tech surgical robots, systems like Endeavor are increasingly looking at investments in care coordination software, community health workers, and home-based care models. These "asset-light" investments are often more effective at driving value than traditional brick-and-mortar expansions.
Ultimately, Halasyamani believes the payment structure—while important for sustainability—should remain secondary to the underlying goal of the medical profession. The challenge for the next decade will be aligning the fragmented American payment landscape with this unified clinical vision. As CMS moves toward its 2030 goals, the industry will be watching systems like Endeavor Health to see if a culture-first, patient-centric approach can deliver the elusive "Triple Aim": better care for individuals, better health for populations, and lower costs.
As the healthcare sector continues to grapple with rising costs and an aging population, the definition of "value" will likely continue to evolve. But as Halasyamani concludes, the most successful systems will be those that realize a patient is more than a diagnosis on a chart—they are individuals with complex lives that require more than just a prescription; they require a partnership.
