Transition to effective value-based care: 10-step buyer blueprint

Sword Summary Warm-up

Don’t have time for the full workout? We’ve got you covered with a quick, high-intensity session. Here are the key takeaways:

• Treat the transition like change management, not just a contract change. Clear ownership and early wins are what keep value-based care alive through leadership changes.¹
• Start where progress is easiest to see. Pick a pilot category where outcomes can be measured consistently, so you can build confidence quickly.²
• Make payment rules simple. Outcome-based pricing makes it clear what “success” means and when payment happens.³
• Design for in-year proof. An independent analysis reported measurable savings and ROI for a digital MSK program, which can help teams show progress within a single plan year.⁴

Why the transition to value-based care keeps stalling

Most benefits and plan teams do not resist value-based care because they disagree with the idea. They stall because the risk feels lopsided.

Fee-for-service is volatile and wasteful, but it is familiar. Value-based care promises better alignment, but the path can feel unclear. Leaders ask how long savings take. Finance asks what will be visible this year. Operators worry turnover will reset the effort before it pays off.

Firstly, shared accountability between the buyer and the care provider makes the transition easier. If you can find a value-based care vendor that offers outcome-based pricing, you can minimize that risk with payments tied to measurable health improvements.

Even so, it helps to run a transition to value-based care like a change program, with clear targets, structured reporting set up from the start, and early proof points to keep key stakeholders confident. When transformation efforts fail, it is often because teams do not build urgency, alignment, and visible momentum early enough.¹

This guide lays out a practical roadmap for employers and health plans. We use MSK as a starting point because it is such a measurable and high impact area of your healthcare budget.

Step 1: Explain “why now” so there is appetite for value-based care

If your “why” needs a constant campaign to make sense, it won’t travel. The first job is to turn the case for value-based care into a compelling and concise business case that finance, benefits, and procurement can repeat without getting lost.

For most employers and plans, the case is simple: 

MSK costs are volatile, low-value utilization keeps slipping through, and the ROI story too often collapses under scrutiny.

A clean “why transition to value-based healthcare” can focus on overcoming these common problems associated with the traditional fee-for-service model:

• costs that swing quarter to quarter, making forecasting painful
• low-value utilization that persists even with utilization management
• pressure to show a clear ROI story to CFOs and committees

Say it plainly: you’re not chasing the label of “value-based”. You intend to drive repeatable savings. You’re trying to pay for recovery and stop avoidable escalation.

Step 2: Check readiness, because contracts don’t run themselves

A value-based contract can be perfectly written and still fail in practice. Not because the idea is wrong, but because the organization isn’t set up to operate it, or because measurement and reporting is vague or inaccurate.

Before you pick a vendor or a program to pilot, do a fast readiness scan:

Leadership and ownership

• Who owns the decision, and who owns the results story?
• What does “success” mean to each stakeholder?

Data and measurement

• What outcomes will you track, and how often?
• Can you match results reporting to financial reporting?

Procurement and contracting

• Can you insist on clear payment rules and audit rights?
• Will procurement support a different commercial model?

Operational capacity

• Who runs implementation, communications, and vendor performance management?
• What will you deprioritize to make room?

Turnover risk

• If you or another key champion leaves, does the program survive?
• Can a new leader understand it in one meeting?

This step helps you avoid a pilot that “runs” but never sticks to earn lasting trust or sustained results.

Step 3: Start with MSK where the proof is easiest to see

Value-based care can feel abstract until you choose a category that makes outcomes and waste visible. That’s why many teams begin with MSK care: it’s common, it’s a massive expense on your budget, and the pathway is often full of avoidable escalation.

MSK is often a strong first pilot because:

• variation is high, so waste can hide in the pathway
• outcomes can be tracked with consistent measures
• conservative interventions can be delivered reliably when pathways are structured²

Step 4: Build a pilot that can reliably prove ROI

A pilot should not be a “let’s see what happens” exercise. It should be built to answer a specific question your leaders actually care about, such as: can we show measurable progress within a plan year, in a way finance can defend?

Start with scope and clarity and choose a segment where a first-year signal is realistic:

• active employees with MSK risk and likely downstream spend
• high-utilization subgroups where escalation is common
• regions with costly provider variation

Then define a first win you can defend. Often that looks like earlier engagement, better outcomes capture, or fewer escalations in a defined cohort. 

Sword is an obvious choice if MSK savings are your target within 12 months. This whitepaper documents how Sword Sword's AI Care reduces unnecessary surgery within the plan year with proactive identification of members at risk of escalation. The result is earlier 84% fewer low-value surgeries and 63% reduction in total MSK surgeries.

Finally, decide what “success” means before the pilot starts:

• which outcomes define improvement
• what threshold counts as meaningful change
• how missing data is handled
• when progress is reviewed

If you skip these definitions, “value-based” quietly becomes “busy.”

Step 5: Choose contract rules that make payment feel fair and predictable

Here’s the moment where value-based care either becomes real or stays aspirational: the payment terms. When payment rules are vague, vendors can claim value without being held to it. When payment rules are explicit, performance becomes governable.

Outcome-based pricing does this well because it ties payment to predefined improvement and spells out the triggers.³ It gives procurement something to evaluate, finance something to forecast, and operators something to manage.

Sword Health’s Outcome Pricing was built for this buyer reality: align cost with measurable improvement, with rules you can point to and reporting you can verify.³ ⁵

Step 6: Treat reporting like the product, not an afterthought

If you want leadership to stay committed to a value-based care transition, you cannot wait until renewal to tell the story. You need a simple way to show progress early, then deepen the story as the year unfolds.

A practical reporting schedule:

• Month 1: implementation milestones, eligibility, adoption, early outcomes capture
• Months 2 to 3: early trajectory signals, engagement patterns, operational frictions to fix
• Months 4 to 6: outcomes plus finance-facing views that match results to spend
• Months 7 to 12: year-one story, renewability, and scale recommendation

Step 7: Assume turnover, and design so the model still works

Many programs quietly assume continuity. Then the workforce churns, leaders change, and the pilot loses traction.

Design for the world you actually operate in:

• make onboarding fast and repeatable
• keep measurement consistent even as members change
• ensure support scales without adding operational burden

Sword’s AI Care programs can help because they create consistent pathways and measurement, with clean reporting and guaranteed savings. The following proof points are so powerful for any internal decision-maker:

• $3,177 Savings per member per year with Sword Health, validated by RSC
• 3.2x Proven return on investment based on medical claims analysis
• 81% Member program completion rate, driving consistent results
• 68% Improvement in productivity among members using Sword

Step 8: Build a small committed team to own the transition

When decisions require five committees, fee-for-service wins by default. Value-based care needs a small group that can make choices quickly and keep the story consistent across stakeholders. This small team will likely include at least some of the following:

• benefits or plan lead (program owner)
• finance partner (forecasting and ROI narrative)
• procurement or legal (contract language, audit rights)
• clinical or population health stakeholder (measurement integrity)
• broker or consultant input when relevant

Step 9: Decide to scale the way a CFO would

At the end of the year, scaling should not feel like faith or guessword. You can expect to make clear decisions based on a repeatable rubric, supported by clear and accuyrate data supplied by your value-based care partners.

Ask for the following commitment from your team and your vendors:

• Outcomes: did you measure improvement consistently enough to trust the results?
• Utilization: did escalation move in the expected direction for the pilot cohort?
• Financials: can you defend the ROI story with clear methodology and reporting?
• Operations: can the program be repeated without heroics?
• Oversight: did leadership confidence increase over time?

Independent analysis confirms measurable savings and ROI for Sword’s MSK program participants compared with non-participants.⁴ That kind of validation can help anchor internal discussions, especially when paired with your own reporting.

Step 10: End with the one thing buyers need: the mechanics

By now, the lesson should feel almost obvious. Value-based care works when improvement is defined clearly and payment follows rules that anyone can understand.

That’s where many vendor evaluations fall apart. Engagement charts are not contract terms. Stories and promises don’t help with accurate forecasting.

Sword pioneered Outcome Pricing in digital MSK, built for the moment when value-based claims have to survive procurement scrutiny and renewal pressure.³ With independently validated ROI and clear payment triggers, investing in Sword gives you the ability to move move forward with confidence in shared accountability and aligned incentives to deliver quality healthcare at scale. You only pay when your the health of your members improves³ ⁴

If you want to explore our outcome-based pricing model in more detail, set up a call with a Sword expert and we will walk through: 

• the outcome measures and improvement thresholds that define success³
• the billing triggers and non-triggers, so you can see what gets paid for and what does not³
• what reporting looks like for finance, consultants, and governance, including how results match invoices³

Start making value-based care governable for the best transition

The transition to value-based care succeeds when it stops being a philosophy and becomes an operating system. That means a a pilot category where progress is visible, measurement that is defined up front, and payment rules that make accountability easy to understand and easy to govern. 

MSK is a practical place to start because the pathway is measurable, the waste is real, and the upside is meaningful when you move care upstream. When you combine that clinical discipline with contracts that tie payment to verified improvement and reporting that reconciles to invoices, value-based care stops feeling like a leap of faith and starts feeling like a plan.

Set up a chat with a Sword expert to see what outcome pricing would look like for your population, plan design, and procurement requirements.¹⁰