However, it also reinforces three pressing questions our team is currently discussing with leaders across the industry.

1. What does it take to build a value-based enterprise?

VBC is a growing movement in healthcare, and has been a stated goal and driver behind industry-wide M&A. While competitors are racing to build and scale value-based care enterprises, it's unclear which models and actors will be successful.

Kaiser Permanente is building a VBC enablement platform for health systems. Geisinger is the first to join. It brings its own health plan, population health expertise, and track-record of developing VBC incentives. Kaiser has its integrated value-based system — though they have struggled to scale its signature closed network model.

This makes us wonder: what capabilities are essential to building a value-based care enterprise? Which ones from Kaiser and Geisinger will be the focus for Risant as they aim to accelerate the growth of value-based care? And how much, if any, integration is necessary to accomplish this?

2. While there has been clear progress in shifting to risk-based payment in the public sector, what is the future of commercial risk?

Risk-based payment is progressing slowly but steadily for Medicare and Medicaid. The same can't be said for commercial contracts, where it's harder to find alignment between plans, providers, and employers on compressed timelines. But commercial risk is ultimately what will tip the industry toward VBC or keep us in a world of hybrid incentives.

Kaiser and Geisinger's stated ambition is to advance VBC. But to truly achieve this, Risant won't be able to ignore commercial risk. How committed will Risant be to advancing VBC across all lines of business, particularly their commercial contracts?  Will they be able to succeed in commercial risk outside of their own health plans?

3. How must home-based care evolve to support VBC?

The future of home-based care and value-based care are inextricably linked. Many home-based care models are only feasible long-term under a risk-based model, yet still these programs remain quite small. And growing VBC requires the industry to provide care to patients across all care settings, which increasingly includes the home. While there has been interest and investment in home-based care in recent years, many models have yet to successfully scale them.

Both Kaiser and Geisinger have shown a desire to approach healthcare with a strong emphasis on preventive care, home-based care, and community outreach to reduce hospitalizations and improve health outcomes. By combining resources, including technology, workforce, and care management techniques, will Risant be able to scale home-based care programs (a notoriously difficult feat)?

These three questions are on the agenda of our VBC summit June 26-27 in Dana Point, CA.