Before the term "value-based care" entered the U.S. health care lexicon, leaders were already being asked to rethink a system that rewarded volume over outcomes. Decades later, the pace of that transition can still make it difficult to tell where experimentation ends and a durable new payment system begins. But the signals coming from the Centers for Medicare & Medicaid Services are getting harder to dismiss.
The agency is pushing more Medicare beneficiaries into accountable care arrangements and asking providers to take greater responsibility for both the quality and cost of care. As Krista Nelson, CEO of Optum Health, confirmed during a recent Newsweek webinar, that direction is increasingly shaping how health care organizations need to operate. "I think CMS' intention and their goal is that every Medicare eligible [person] has access to value-based care," Nelson said, speaking to an audience of health care leaders during a virtual fireside chat on August 17.
"And it's not just through Medicare Advantage that you can get access to value-based care," Nelson added, describing CMS’s vision for a future in which "that kind of model, that kind of investment is offered for everybody in traditional Medicare as well." CMS has explicitly described its value-based programs as part of a broader effort to shift Medicare from paying providers based on the quantity of care they deliver toward rewarding the quality of that care. Increasingly, that philosophy is showing up not only in experimental payment models but in the financial architecture surrounding Medicare. Beginning in 2026, for example, physicians who qualify through participation in Advanced Alternative Payment Models receive a higher annual Medicare Physician Fee Schedule update than clinicians who do not: 0.75 percent versus 0.25 percent.
The CMS Innovation Center's current strategy goes further, calling for future models to expand prospective payments and advanced shared savings while moving Medicare and Medicaid beneficiaries toward accountable care arrangements in which providers assume global downside financial risk. CMS reinforced that direction again last month. Its proposed 2027 Medicare Physician Fee Schedule would make changes intended to expand participation in accountable care organizations and move clinicians away from traditional MIPS reporting toward what the agency describes as more meaningful value-based pathways.
Meanwhile, more than 700,000 health care providers and organizations are participating in Medicare accountable care initiatives in 2026. As the details of individual programs continue to change, the broader question for health care leaders is what those payment signals add up to, and how organizations should respond while the value-based model is still a work in progress. It's the question that health care stakeholders hoped to unpack when Nelson, CEO of one of the largest physician organizations in the United States, took the virtual stage to discuss leadership in the value-based care economy.
Optum is the health services business of UnitedHealth Group, the largest U.S. health care company by revenue and No. 3 overall on the 2026 Fortune 500 (behind Amazon and Walmart, and ahead of Apple and Alphabet). With a presence in all 50 states and the District of Columbia, Optum supports more than 120 million customers, according to UnitedHealth Group's most recent earnings report. Through Optum Health, the company delivers and manages care across primary, specialty, surgical, behavioral and home-based settings, giving Nelson a particularly expansive view of the industry's shift toward value.
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