What Do Payviders Mean for the Future of Value-Based Care?

Payviders embrace a powerful strategy for scaling value-based care. By aligning financial incentives directly to integrated healthcare systems, payviders can improve care coordination, data collection, and accessibility for members.

The Payvider Advantage

Payviders close the gap between payer and provider to unlock distinct advantages for the organization and its constituents.

For instance, Humana touts integrated care for 65,000 members in a risk model served by Humana-owned provider groups, from CenterWell Senior Primary Care to CenterWell Home Health or One Home Health for rehab and chronic condition management, to Humana pharmacy.

On the provider side, AdventHealth created Select Plan, a narrow-network VBC plan, as an alternative to traditional employer insurance. Network providers choose to participate in the Select Plan, which also includes wraparound services built and operated within AdventHealth. In 2025, the plan saw that 92% of its members — a fraction of the 148,000 people it provides benefits to — complete a primary care visit by midyear.

AdventHealth attributes its success to attractive benefits, self-selecting VBC providers, a nearly 10-year-old integrated network, and proactive care coordination by clinical teams. McKinsey notes that having a commercial insurance arm can help providers stay relevant in a consolidating market in which payers may bump providers out of their networks.

Successful payviders can achieve VBC goals through:

• Leveraging integrated services to reduce unnecessary hospitalizations and improve member experience.
• Enrolling high-risk individuals in multi-disciplinary care management programs to support the right services at the right time, further containing costs.
• Scaling the model across physician groups, outpatient clinics, and hospitals to eliminate fragmentation, grow health plan membership, improve population health outcomes, and capture savings as profit.

While the payvider model offers significant opportunities, organizations must also overcome operational and financial challenges to achieve long-term success.

Payvider Promise and Problems

Payviders may represent one of the most promising pathways for advancing value-based healthcare. By combining payer and provider functions, these organizations can:

• Better coordinate affordable care across their patient population.
• Streamline administrative processes, scale programs like behavioral health and VBC cancer care, and optimize risk-coding.

Payviders align care delivery with financing. This investment in shared data and care navigation reduces fragmentation and engagement barriers. Through an integrated system with collaborative workflows, quality and outcomes should flourish as access grows.

At the same time, the payvider model has some significant challenges. Connecting financing and care delivery demands technology infrastructure and monetary reserves that providers don’t have and sourcing and resilience skills equally foreign to payers. Plus, rising healthcare and labor costs constrain margins, particularly as workforce shortages and wage inflation increase the cost of delivering care. Contraction hurts payviders’ capacity to manage VBC operations, administration, and technological functioning.

Plus, success depends on how well payviders manage novel issues:

• Geographic and specialty limitations (especially for provider-led payviders)
• Operational infrastructure for health system – health plan alignment
• Medical loss ratio pressures
• Clinical and billing data integration

These pressures can make it hard for payviders to sustain high-quality service while delivering the affordability and consistency that value-based care promises.  

Payviders in Position for VBC Wins

Payviders are well-positioned to play a bigger role in the future of value-based care, especially as employers and health systems look for ways to improve quality while controlling costs. Their integrated model gives them an advantage in coordinating care, improving access, and aligning incentives around better outcomes rather than higher volume.

The opportunity is clear: Payviders that can combine risk-based product innovation with proactive clinicians in comprehensive, cost-optimized care networks may be able to turn operational integration into a real competitive advantage.

• Payviders are well-suited to deliver better care coordination and affordability.
• Payviders can expand value-based care by developing specialty-focused CoEs for high-cost, high-utilization services (e.g., bariatric surgery, transplants, orthopedics, cardiac care).

Payviders are not just part of the future of value-based care; they may become one of its most important enablers.

AccuReports: Payviders’ Tool to Manage Financial Performance

AccuReports by FRG empowers payviders by unifying data on a single platform to better manage performance in risk-based contracts. The web-based platform improves visibility into cost, utilization, and clinical and operational performance to support health plans and health systems in centralizing care coordination and data collection as they reinvent themselves into payviders.

To learn more about FRG, your partner for healthcare financial intelligence, contact us or call 888-466-1025.