This article is our answer. It is perspective, not prediction, and the facts are limited to what CMS and other government sources have published. If you want the models explained first, start with our explainer on what value-based contracting is and our map of the value-based care ecosystem. Here we want to look forward.
Where Value-Based Care Stands Today
Value-based care is not a pilot. Medicare’s Shared Savings Program is fourteen years old and is the largest accountable care program in the country. In performance year 2024, 476 participating organizations cared for 10.3 million beneficiaries, three quarters of them earned shared savings totaling $4.1 billion, and Medicare still saved $2.5 billion against its benchmarks after paying them.
Participation is still climbing. As of January 2026, 14.3 million people with Medicare receive care coordinated by an accountable care organization, up 4.4% in a year, and the Shared Savings Program alone has 511 ACOs serving 12.6 million people with Traditional Medicare. On the other side of the Medicare ledger, 55% of eligible beneficiaries, 35.5 million people, are now enrolled in Medicare Advantage plans, which are paid on a risk-adjusted basis and, in our experience, have moved risk-based terms down to providers faster than anyone else.
Those are the numbers. The more important story is what the rules are doing.
The Policy Direction Is Set, Even as the Details Change
Administrations change, and so do model names. The direction does not. In May 2025 the CMS Innovation Center published a new strategy built on three pillars: evidence-based prevention, empowering people to reach their health goals, and choice and competition. These pillars are anchored in a commitment to protect taxpayers by favoring models that show real savings. Instead of restating the earlier goal of having every Traditional Medicare beneficiary in an accountable care relationship by 2030, the CMS Innovation Center put a set of models on the calendar, including:
- TEAM, the Transforming Episode Accountability Model, started in January 2026: a five-year, mandatory, episode-based model for hospitals in selected regions, covering five surgical procedures and the 30 days after discharge.
- ASM, the Ambulatory Specialty Model, starts in January 2027: a five-year, mandatory model that holds selected specialists treating heart failure and low back pain financially accountable, with Medicare Part B payment adjustments that start at plus or minus 9%.
- LEAD, the Long-term Enhanced ACO Design Model, starts in January 2027 and runs ten years, to 2036: a voluntary ACO model with benchmarks that are never rebased, explicit support for small and independent practices, and new options for ACOs to partner with specialists through episode-based risk arrangements.
- EOM, the Enhancing Oncology Model, was extended to June 2030 and took on a second cohort in July 2025.
Inside the permanent Shared Savings Program, 82.8% of ACOs now sit in the two-sided risk tracks, the highest share since the program began, and the 2026 physician fee schedule rule was written to push that number higher.
Read those together and the message is simple. The question is no longer whether payment moves toward value. It is on what timeline, and on whose terms.
Four Trends Shaping the Next Five Years
Each of these follows from what is already on the calendar, and each ends with what we think it means for a practice.
1. Specialty care joins the model
Value-based care grew up in primary care, but the spending is in specialty care, and that is where CMS is now aiming. TEAM covers surgical episodes. ASM is the first mandatory model for outpatient specialists. EOM covers systemic cancer therapy. LEAD gives ACOs a CMS-administered way to write episode-based risk arrangements with specialists. This is OMI’s home turf; our programs in retina, oncology, and rheumatology were built for exactly this shift.
What it means: specialty practices will be in value-based arrangements within a few years either way. The choice is whether you enter on terms you helped shape. Our guide to value-based care contracts for specialty providers covers the terms, and our executive guide to the specialty cost paradox covers the economics.
2. Data moves to the point of care
Contracts are settled after the fact, but performance is created one clinical decision at a time. The organizations that do well in a two-sided world are the ones that can see performance during the year and act on it in the exam room, not the ones that receive a good report at reconciliation. The advantage is shifting from who has data to who has it at the moment a treatment decision is made.
What it means: treat point-of-care support as infrastructure, not an add-on. Our explainers on point-of-care decision support and value-based care analytics cover what that looks like in practice.
3. Risk keeps shifting, and enablers absorb it
Every model above moves risk toward providers: mandatory participation, two-sided tracks, payment adjustments that cut both ways. At the same time, CMS says it wants small and independent practices in. Those two facts do not reconcile on their own. An independent specialty practice cannot carry population-level risk on its balance sheet, and most cannot build the benchmarking, attribution, and reporting machinery a contract needs. That gap is what enablement partners exist to close, and in some arrangements, they absorb the financial risk as well.
What it means: the partner you choose decides where the risk stops. Our ecosystem article explains the roles, and our guide to evaluating value-based care solutions gives you seven questions to put to any partner.
4. Payors beyond Medicare follow
Medicare sets the template and other payors adopt it. Medicare Advantage plans, which now cover 55% of eligible beneficiaries, have led the movement of provider payments into risk-based arrangements, and commercial plans follow more slowly; the payment-share question below has the numbers. EOM was designed as a multi-payor model from the start, with commercial payors participating alongside Medicare.
What it means: the share of a practice’s revenue touched by value-based terms keeps growing across payors, so the capability you build for one contract gets reused for the next. Build it once and build it to seamlessly integrate into multiple systems.
What This Means for Practices
Waiting is a position, and it has a cost. Practices that enter now under upside-only arrangements learn the model, build a performance history, and shape their benchmarks while the downside is zero. Practices that wait may enter later under terms that include risk, and for specialists in the markets ASM selects, the choice goes away altogether.
Our view is that the practices doing best in five years will be the ones that started with no downside, learned on their own data, and moved up the risk ladder only when their numbers said they could. Our post on how physicians are actually paid in value-based care shows what that path looks like at the level of individual compensation.
Where OMI Sits
OMI builds the on-ramp. Our programs run on a one-sided shared savings model: participating practices carry no upfront cost and no downside exposure. If a program generates savings, providers share in them. If it does not, there is nothing to pay back. OMI holds the payor contracts, administers the programs, and supplies the point-of-care decision support and real-time performance reporting they run on through the OMI PULSE platform. Our focus is specialty care, in ophthalmology and retina, oncology, and rheumatology, with more specialties in development. If that describes your practice, our programs were built for the shift described above. If it does not, the trends still hold, and the evaluation guide will help you find the right partner.
Common Questions
Is value-based care growing?
Yes. The number of people with Medicare in ACO-coordinated care rose from 13.7 million in 2025 to 14.3 million in 2026, and the Shared Savings Program grew to 511 ACOs serving 12.6 million people with Traditional Medicare, a 12.3% increase in a year. New mandatory models are adding hospitals in 2026 and specialists in 2027.
Will fee-for-service go away?
Not soon, and probably not entirely. Most value-based arrangements, including the Shared Savings Program, TEAM, and ASM, keep fee-for-service billing in place and settle performance on top of it. The likely future is hybrid: fee-for-service as the billing chassis, with payment for outcomes deciding whether a practice thrives.
What share of healthcare payments are value-based?
For Medicare, the accountable care numbers above tell the story, and Medicare Advantage now covers a majority of eligible beneficiaries. Across all payors, the industry measurement effort that has tracked payment models since 2016 found that in 2023, 28.5% of U.S. healthcare payments flowed through contracts with downside risk, with Medicare Advantage well ahead of commercial plans. The share of payments with some link to quality or value is far higher; the share with real risk is the number to watch.
Is value-based care the future of healthcare?
For every part of healthcare where outcomes and total cost can be measured, yes. Where they cannot yet be measured well, fee-for-service persists. Specialty care is crossing that line now, which is why the models above exist and why the next five years matter more than the last ten.
Where to Go From Here
If you were still weighing whether the shift is real, we hope this settles it. If you are ready to compare partners, our guide to evaluating value-based care solutions is the next step, and our specialty contracts guide covers the terms you will be offered. If you would rather talk it through, that is what the offer below is for.
The shift is happening on a timeline. Enter it with no downside.
OMI builds upside-only programs that connect payors and providers in value-based care. Talk to us about what the next five years look like for your specialty, and what it would take to start now with nothing to pay back.
Or hear OMI CEO Dr. Andrew Pecora on the future of value-based reimbursement.