1 Introduction

Value-based healthcare (VBHC) is a healthcare delivery model that focuses on improving patient outcomes while reducing costs by prioritizing quality over the volume of services provided. Providers are incentivized and reimbursed based on the value they deliver, which is measured as health outcomes achieved per unit of cost, encouraging coordinated care, prevention, and evidence-based practices (Leao et al. 2023). VBHC is a patient-centered model that focuses on delivering care that provides maximum value to patients. Unlike traditional fee-for-service models, VBHC shifts the emphasis to outcomes that truly matter to patients, such as quality of life, patient experience, and long-term health goals (Porter 2010). However, While VBHC models can be implemented in various settings, implementing VBHC across large, multisite health services presents both unique opportunities and significant challenges. In multisite health services, there is added complexity and variation involved in scaling the rollout of value-based health care models. Opportunities such as improved standardization of care, cost efficiency, and better data utilization are met with challenges such as coordination complexity, data interoperability, and the cultural shift required among healthcare professionals (Zanotto et al. 2021). In our organization, which operates 11 privately run healthcare facilities across a vast geographic area, understanding and addressing these dynamics is essential for ensuring a successful transition to VBHC.

2 Opportunities Provided by Implementing Value-Based Healthcare

VBHC prioritizes a patient-centered approach, tailoring care to meet individual patient needs and preferences, which is crucial for improving health outcomes (Porter 2010). In multisite health services, VBHC aims to standardize care in line with best practices across all locations, ensuring consistently high-quality care is provided. This standardization can reduce variations in care quality and health outcomes across different facilities and patient populations, ultimately promoting equity in healthcare delivery and the overall patient experience with the health service (Leao et al. 2023).

By focusing on efficiency and outcomes, VBHC encourages the allocation of resources toward interventions that offer the greatest value to patients. Large health systems can negotiate better prices for supplies and streamline operational processes (Leao et al. 2023). This shift from volume-driven models to value-driven approaches can significantly reduce unnecessary expenditures, ultimately lowering healthcare costs while maintaining or improving care quality (Zanotto et al. 2021).

Multisite health services often have access to large amounts of patient data. A VBHC model can enhance the utilization of this data for clinical decision-making and drive continuous improvements in care delivery. Implementing VBHC encourages the systematic use of data for outcome measurement, predictive analytics, and real-time performance monitoring (Teisberg et al. 2020) This data-driven approach not only helps identify areas for improvement but also facilitates targeted interventions that align with patient-specific needs, leading to better health outcomes (Zhang et al. 2025).

VBHC fosters interdisciplinary collaboration and integration of care pathways, which is particularly advantageous in large, multisite health systems. By promoting coordination among diverse care teams, VBHC facilitates seamless transitions between care settings, enhancing communication and ensuring continuity of care (Teisberg et al. 2020). This collaborative approach improves the patient experience, as patients benefit from comprehensive care that is tailored to their needs and delivered in a coordinated, integrated manner across all stages of their healthcare journey (Fernández-Salido et al. 2024).

Meaningful collaboration with external partners including consumers, healthcare funders, policymakers, and technology providers creates opportunities for accelerating the adoption of VBHC. These partnerships bring diverse perspectives, align incentives, and support the co-creation of solutions that are both patient-centered and system-responsive. As highlighted by van Staalduinen et al. (2022), such collaboration strengthens the foundation for sustainable change by bridging the gap between policy, practice, and patient needs.

3 Challenges Identified From a Multisite Healthcare Service Perspective

Despite the opportunities offered by VBHC, its implementation in a multisite health service requires effective coordination across diverse facilities, each with its unique infrastructure, workforce, and patient demographics. Ensuring alignment in goals, processes, and outcomes can be challenging, particularly when sites are geographically dispersed (Teisberg et al. 2020). The coordination of care across various locations with differing operational cultures and resources often leads to inefficiencies, which can hinder the standardization of practices and delay the adoption of VBHC (Fernández-Salido et al. 2024).

While large health systems generate substantial amounts of data, the lack of standardization and interoperability between disparate electronic systems and documentation practices remains a significant barrier. These issues complicate the comparison and integration of outcomes across sites, making it difficult to measure and monitor performance effectively. Efforts to establish common data standards and facilitate system integration are essential for a seamless VBHC transition (Zhang et al. 2025).

Transitioning to VBHC necessitates a cultural shift among clinicians, administrators, and staff, which often results in faceresistance, particularly in systems accustomed to traditional fee-for-service models (Fernández-Salido et al. 2024). Overcoming this resistance requires engaging stakeholders at all levels and fostering a shared vision for VBHC, as well as addressing concerns about job security, changes in clinical workflows, and compensation structures (Teisberg et al. 2020). Education and training programs for healthcare professionals, including doctors, nurses, and allied health care staff, are essential to ensure a smooth transition to VBHC, promoting a culture of value-driven care (DeCorby-Watson et al. 2018).

The initial investment required to implement VBHC such as infrastructure upgrades, system integration, and staff training can place significant strain on budgets, particularly for health services already operating on tight margins (Leao et al. 2023). Additionally, the financial tension between value-based and volume-based reimbursement models poses challenges, as early adopters may face financial penalties from reduced service volumes before the value-based incentives are fully realized (Leao et al. 2023).

Measuring value in healthcare is inherently complex, as outcomes vary significantly across patient populations, conditions, and care settings (Zanotto et al. 2021). Developing robust and comprehensive metrics to accurately capture value is challenging. Furthermore, even when metrics are quantifiable, such as Quality-Adjusted Life Years (QALYs) or Patient-Reported Outcome Measures (PROMs), clinicians and decision-makers often lack the necessary training to interpret and apply this data effectively in practice, which impedes decision-making and the continuous improvement of care (Zanotto et al. 2021).

4 Recommendations for Multisite Organizations

Successfully implementing VBHC in large multisite health services requires strategic planning, phased implementation, and key actions to ensure alignment with VBHC goals. First, stakeholder engagement is crucial, requiring transparent communication among clinicians, hospital leaders, patients, and consumers to ensure buy-in and a shared vision (Teisberg et al. 2020). Second, investing in technology to upgrade digital systems and establish data-sharing platforms enables effective outcome measurement and real-time performance monitoring (Zhang et al. 2025). Third, pilot programs allow for testing and refining processes before broader implementation, reducing resistance and improving uptake (Teisberg et al. 2020). Lastly, collaboration with external partners, including consumers, healthcare funds, policymakers, and technology providers, provides pathways to overcome challenges and accelerate VBHC adoption (van Staalduinen et al. 2022).

Implementing VBHC in a large multisite health service is complex, involving challenges such as coordination, data integration, and cultural resistance. However, the potential to improve patient outcomes, optimize costs, and enhance overall healthcare delivery outweighs the time and resources required. A key barrier to success is the failure to translate high-level concepts into clear, actionable strategies that are understood and embraced by all stakeholders. To overcome this, a deliberate, collaborative approach is essential. By fostering alignment among all partners, health systems can successfully transition to a value-driven model, ensuring both high-quality care for patients and more sustainable operations for health service providers.

Author Contributions

Kathryn Kynoch: conceptualization, writing – original draft, writing – review and editing. Catherine Cooper: writing – review and editing. Chris Foley: writing – review and editing. Mike Beckmann: writing – review and editing.

Conflicts of Interest

The authors declare no conflicts of interest.