At NAACOS this year, the conversations were focused on execution, with less emphasis on defining models and more on how organizations are expected to operate within them.

CMS continues to push forward. Programs like ACO MSSP, REACH, and LEAD are extending the reach of value-based models, while interoperability expectations and data-sharing requirements are becoming more clearly defined across agencies and networks.

This direction is not tied to a single moment in time. It reflects a broader, longer-term shift, with primary change being how quickly more organizations are expected to participate.

Accountable Care Organizations Face Uneven Readiness

Accountable Care Organizations (ACOs) have never been uniform in their structure or resources. That was evident throughout NAACOS, not as a new insight, but as a constraint that is becoming harder to work around. Organizations vary widely, from independent physician groups to health system-led ACOs, regional collaborators, and those operating with more limited infrastructure.

Those differences have always existed, but the level of expectation being applied across that spectrum is increasing.

As organizations enter programs like LEAD, many are doing so without the same foundation that earlier participants had time to build, particularly given the program’s long-term structure. This creates a practical challenge around execution.

Why Value-Based Care Is Still Hard to Implement

There was a level of openness in how these challenges were discussed.

At NAACOS, operators were not presenting ideal-state models. Instead, conversations focused on how to manage specific populations, work within limited resources, and adapt models that were not originally designed for their environment. There was a willingness to share what is working and where things are falling short, which highlighted how uneven the starting point remains across the market.

The Role of Healthcare Interoperability in Value-Based Care

Data sat behind many of these discussions.

Healthcare interoperability is advancing, with standards like FHIR continuing to evolve, alongside the expansion of national frameworks and network-level data exchange.

At the same time, organizations are expected to operate across multiple systems, partners, and care settings with health data that is often incomplete or untimely. For some, the necessary capabilities are already in place, for others, they’re still being developed—often in parallel with active participation in value-based programs.

Health Data Sharing Models Are Evolving Beyond Traditional HIEs

This is where the conversation around health information exchange is shifting.

There are still many strong HIE organizations playing an important role in their regions, and that remains an important part of the landscape. However, the broader requirements aren’t tied to a single model.

Organizations need the ability to exchange healthcare data across networks in a way that supports care delivery and population management. How that is achieved will vary, whether through formal HIE participation, direct connections between partners, IDN-led “hub-and-spoke” models, or national frameworks and hybrid approaches.

The expectation itself is becoming more consistent, even as the models differ. In practice, success in value-based care depends on the ability to coordinate care, access timely data across systems, and adapt workflows to fit local operating conditions.

Key Challenges in Population Health Management and Care Coordination

NAACOs also surfaced some of the pressure points organizations are actively working through.

These include how to support rural health initiatives under tight timelines, manage new populations entering value-based arrangements, and better align clinical workflows with the data available.

Many of these issues remain unsolved, but the level of engagement from the people responsible for making these models work was notable.

What Organizations Need to Succeed in Value-Based Care

From a leadership perspective, the focus is less on defining the direction of value-based care and more on how organizations build the capabilities required to support it in their specific context.

That includes working across different data sources and systems, supporting clinicians with usable, timely information, and adapting models to fit local realities rather than applying a single approach. These are not new ideas, but the urgency behind them is increasing.

The Future of Value-Based Care Depends on Data Integration and Adaptability

NAACOS emphasized that progress in this space will not come from a single model or a single approach. It will come from organizations continuing to adapt, share what they are learning, and build the practical capabilities needed to operate in value-based care environments, including care coordination and data integration across systems.

That work is already underway, but keeping pace with the rapid evolution of expectations remains a challenge.

James Henderson
SVP & General Manager, U.S. at Orion Health
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