Risk-Based Contracting:
Fad, Fantasy, or the Future of Primary Care?
December 10, 2025
Health care represents a large portion of all spending in the United States, and current models expect health expenditures to grow faster than the rest of the economy over the next 10 years, continuing an unsustainable trajectory for patients, employers, providers, and payers alike. Value based care and risk contracting have been promoted as ways to improve care quality, eliminate waste, and curb ever-rising healthcare costs. Yet for all the hype, adoption in the commercial primary care market has been slow, and opinions are divided: are these models truly viable?
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Missouri Health Value Collaborative (MHVC) held its fourth Community Connections forum on December 10, 2025, sparking a spirited discussion between clinicians, purchasers, health systems, payers, and benefit consultants on rising healthcare expenditures, commercial payment models, and risk contracting to enable high value primary care. The latest installment of MHVC's multistakeholder series paired local health system leaders with national expertise to evaluate the promise, pitfalls, and progress of “value-based care” in commercial markets:
​​"The current trajectory of the U.S. health care system, one which increasingly depletes social wealth without generating commensurate gains, is unsustainable."
Dave Thompson, President of Population Health at Mercy, set the tone for the day by emphasizing the need for better commercial payment models amid rising costs and market pressures. ​​
From Brinksmanship to Statesmanship:
A Pivot in Payer/Provider Partnerships
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Thomas Robertson, National Advisor for Manatt, identified where our current health care models are failing and advocated for new, collaborative payer/provider partnerships focused on chronic care management and reducing system price variation.
Inside St. Louis: Primary Care Leaders on Risk and Regional Efforts
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MHVC assembled St. Louis' Primary Care Dream Team to offer an inside look at how local health systems and physician organizations are working to improve primary care delivery for commercial patients.
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(Left to Right: Tom Hastings - Esse Health, Kalyan Katakam - SSM Health, Doug Pogue - BJC Health, Tracy Riordan - Mercy)
A Game of Risk and Reward
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Participants engaged in a lively card trading game to connect with each other and cap off a morning of debate and energetic discussion!
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Sponsors of Community Connections
This Community Connections event and its invaluable discourse would not be possible without generous support from MHVC's event sponsors:
Join The Conversation
Register for MHVC's next Community Connections here, or find out more ways to get involved by reaching out to Justin Powless at jpowless@gatewaybhc.org.