VBC Market Dynamics

The VBC market is shifting toward more sophisticated risk intermediation: third-party ACO conveners are reshaping MSSP participation by assembling geographically dispersed, high-performing provider networks, while vendors such as Arbital Health are launching tools to model downside exposure under CMS’s LEAD ACO program—signaling that actuarial, data, and capital capabilities are becoming core infrastructure for ACO strategy (Health Affairs on ACO conveners). At the same time, provider-led organizations are trying to close capability gaps through clinically integrated networks, specialty VBC models, AI-supported HCC documentation, and bundled-payment analytics, as MA enrollment remains dominant and the Trump administration’s 2027 MA rate update reinforces the continued strategic importance of Medicare risk markets. For health systems and ACO leaders, the tension is clear: scale and technical enablement are increasingly necessary to succeed in MSSP, LEAD, MA,