Population Health Management

Population health management is moving deeper into specialty risk and operational execution: Blue Cross NC’s Advanced Kidney Care program shows payers using risk-aligned partnerships for CKD/ESRD management, while Strive Health and similar kidney-focused platforms are doubling down on AI, advisory depth, and care model infrastructure to support value-based kidney care at scale (HCTTF case study). At the same time, health systems are tightening the mechanics of VBC performance—Prisma Health is embedding care managers, transition nurses, ED navigators, and interdisciplinary pods into frontline workflows, and AtlantiCare is investing in HCC coding accuracy to improve risk stratification and reimbursement alignment (Prisma Health care model). The strategic tension for ACOs, payers, and health systems is no longer whether VBC will expand, but whether organizations can build the data, coding, care-management, and specialty-partnership capabilities needed to manage risk while still operating under mixed fee-for-service and value-based payment environments.