McDonald’s Can’t Become Fine Dining (Still a Smaller Leap than VBC)
Value-based care isn’t failing because the models are flawed. It’s failing because the organizations implementing them weren’t built to survive the shift.
On this episode of Outcomes, I interviewed David Muhlestein —one of the nation's leading VBC architects, former Chief Research Officer at Leavitt Partners, and a trusted advisor to CMS and Medicaid redesign efforts.
His assessment:
TL;DR
1. Data is not the bottleneck. Organizational design is. Winning organizations aren’t data-rich—they’re structurally aligned.
Code for success:
✅ Identify internal champions early
✅ Build protected cohorts around them
✅ Commit to a 3-year strategy horizon
2. Segmentation must include people, not just patients. One high-performing health system selected its 100 most VBC-ready physicians, created targeted infrastructure, and scaled after results.
3. Social care programs stall without long-term contract alignment. Short-term pilot cycles cannot sustain 10-year transformation ambitions.
Design social care around multi-year risk contracts and actuarial logic—not grant timelines.
4. Excess data erodes performance. Frontline teams cannot act on overloaded dashboards.
If your organization is serious about leading in value-based transformation:
“We’re asking for 10-year transformations—but still measuring them on 12-month cycles.”
If your team is navigating transformation under HR1 or margin pressure, subscribe to The Fundable 15—my weekly brief on what makes social care fundable, scalable, and system-ready.
— Christina R. | SDOH Strategist | Outcomes Podcast Host | Margin Defense Architect
Helping healthcare leaders design systems that hold.
Your articles are awesome Christina Y. Rodriguez