The formula for value-based care in orthopedics to thrive

In a recent conversation with Becker’s Spine Review, I shared a perspective that continues to come up in orthopedics: value-based care isn’t falling short because of lack of interest — it’s falling short because the infrastructure to support it hasn’t been built the right way. For years, the industry has talked about moving away from fee-for-service, but most models stop short of true accountability. They introduce elements of value without fully aligning incentives, measuring outcomes in a meaningful way, or putting real risk on the table. Without those components, it’s difficult to create the consistency and predictability that value-based care is meant to deliver. Orthopedics makes this gap especially clear. Variation in care, inconsistent pricing, and uneven outcomes persist not because the solutions are unknown, but because the system isn’t structured to support them at scale. Incremental changes layered onto legacy models won’t get us there. The path forward is more deliberate. It requires aligning surgeons, facilities, and payors around shared outcomes, building systems that measure what actually matters, and shifting care to the most efficient settings — increasingly, that means ambulatory surgery centers. This isn’t just a policy issue. It’s a market design challenge. If we want value-based care in orthopedics to truly scale, we have to move beyond pilots and partial solutions and build models designed for performance from the ground up.