It seems obvious to me that "value based care" and "managed care" won't solve the US outlier position for healthcare costs. But we've got a headline article in Health Affairs that makes the point.
See January 23, 2026:
Value-Based Payment And Managed Care Will Not Solve The Affordability Crisis
Ryan, Rooke-Ley, Berenson (Brown Univ. & Urban Institute)
Among the unsurprising data shown here, Bond and colleagues in 2025 JAMA found that ACOs saved $300/pt after six years. Ryan et al. point out that in the target year, 2019, that was $500M savings compared to $800B spending - a small fraction of 1%. Open access and good reading.
The authors give some airtime to concerns that technology drives healthcare costs. We could go vastly farther in encouraging technologies that save healthcare costs, instead of making them almost impossible to adopt. (For a promising example see PaigePredict here. I'm not promoting this particular example, but rather, it stands-in for a whole class of beyond-the-horizon breakthrough efficient technologies that deserve attention0.
___The article doesn't have an abstract but here's a 200 word summary [Chat GPT 5.2]:
Policymakers keep backing value-based payment (VBP) as the fix for U.S. health care costs, shifting from fee-for-service to risk contracts like ACOs and Medicare Advantage.
But decades of experience show minimal or no real savings. Even the most optimistic recent ACO studies suggest Medicare savings of only 0.06–0.13%, and those estimates are likely inflated by patient selection and diagnostic upcoding, not true efficiency. Meanwhile, CMS bonus payments and gaming may mean net losses.
Claims that VBP indirectly slowed national spending growth (“spillovers”) don’t hold up. The U.S. slowdown began before the ACA and occurred across OECD countries with very different payment systems. The more plausible driver was a temporary lull in diffusion of expensive medical technologies, not payment reform.
Conceptually, VBP targets the wrong problem. U.S. costs are not mainly due to excess use of routine services; compared to peers, Americans often use fewer hospital days and doctor visits. The real drivers are high unit prices, adoption of costly new technologies, and administrative overhead. ACOs can’t control hospital pricing or tech adoption, and only capture a fraction of savings they generate.
Bottom line: VBP outsources cost control to intermediaries while leaving core pricing and coverage decisions untouched—so it can’t solve long-term cost growth.
