Investors at the AIF Roundtable argued that value-based care is not dead, it just moved to Medicaid, where complex-care platforms are aligning payment with outcomes and producing durable behavioral health companies that fee-for-service mental health cannot.
Key Takeaways
- Value-based care has not failed; the lens has been wrong. Panelists argued that the market wrote off value-based care because it equated the model with the Medicare Advantage primary-care-risk template. The more successful examples increasingly sit in Medicaid, where complex, high-cost populations create the alignment the model needs.
- Fee-for-service mental health is the hard road. Standalone, fee-for-service behavioral health pays poorly and leaves little room between revenue and clinician income, the panel said. Without a way to capture savings elsewhere in the system, those businesses struggle to become durable.
- Whole-person Medicaid models can be profitable and effective at once. Imagine Pediatrics and CareBridge were cited as proof that integrated, value-based Medicaid care can lower total cost while improving outcomes. The shared mechanic is keeping high-need patients out of the hospital, which is where Medicaid spend concentrates.
- Budget pressure may force the shift to paying for outcomes. With Medicaid under fiscal strain, panelists predicted that payers and policymakers will increasingly tie payment to outcomes rather than volume. They framed that pressure as an opportunity to realign incentives across behavioral health.
For several years, the conventional wisdom on value-based care has trended toward disappointment. High-profile primary-care-risk companies stumbled, public-market valuations compressed, and a model once sold as the future of American healthcare started to read, in some investor circles, as a cautionary tale. At the Autism Impact Fund Investment Roundtable, moderated by Kelly Evans, anchor of CNBC’s “The Exchange” and co-anchor of “Power Lunch,” Annie Lamont offered a pointed correction. The problem, she argued, is not the model. It is that everyone has been looking at the wrong version of it.
“People think of value-based almost as dead because they think of it all as ChenMed, Oak Street, some of the other examples of companies that they’re all primary care taking risk to Medicare Advantage,” said Lamont, founder and managing partner of Oak HC/FT. “That is the model that seems to be in everybody’s head. But the reality is some of the most successful value-based care companies have been like CareBridge and Medicaid and Imagine and Medicaid, and they end up being win-win-wins.”
The reframing matters for behavioral health specifically, because it suggests the sector’s path to durable economics runs through Medicaid complex-care arrangements rather than through the fee-for-service models that dominate mental health today. It is an argument with real evidence behind it, and real constraints around it.
Why Value-Based Care Works With Complex Medicaid Populations
The logic of value-based care depends on there being savings to capture. A provider that takes accountability for total cost of care only profits if it can reduce avoidable spending while maintaining or improving outcomes. In a relatively healthy, lower-cost population, the margin for that arithmetic is thin. In a population of medically and behaviorally complex Medicaid patients, where a single avoidable hospitalization can dwarf a year of outpatient care, the opportunity is large.
That is the population Imagine Pediatrics built around. The Nashville-based group delivers 24/7 virtual and in-home care to children with special healthcare needs, primarily through Medicaid value-based arrangements, and CEO George Boghos described the economics plainly. “The way Imagine makes money is we have to, while delivering great outcomes, reduce the spend on healthcare for our kids and families,” he said. “We don’t take anything away. The only thing we take away is time spent in the hospital unnecessarily.” He said the company is profitable, reduces total spend for its population by roughly 10%, and maintains a net promoter score above 90 with families. The model expanded into Georgia, Missouri, North Carolina, and New York in January 2026, following a $67 million Series B round backed in part by Oak HC/FT and the Autism Impact Fund.
Lamont’s other example points to where the model can lead. CareBridge, a value-based manager of home- and community-based services for complex and dual-eligible Medicaid members, was acquired by Elevance Health’s Carelon division for a reported $2.7 billion, a deal completed in December 2024. Founded in 2019 by former Center for Medicare and Medicaid Innovation director Brad Smith and former Senator Bill Frist, CareBridge reached more than 115,000 patients across 17 states and Washington, D.C. before the sale. In a sector where panelists said exits are genuinely hard to come by, it stands as evidence that whole-person Medicaid platforms can produce the kind of liquidity event investors need to keep funding the category.
Lamont described the human mechanics that produce the savings, recounting a case from Imagine’s work: a mother facing eviction whose child depended on a ventilator and other equipment, headed toward a homeless shelter she could not safely bring the equipment to. “Georgia’s team calls the state, explains the situation, keeps the child in the home,” she said. “It’s these complex issues of just managing day-to-day life that having some institution that’s advocating for you ultimately does save costs for the system.” The most expensive outcome, she noted, is almost always a hospitalization, and an advocate who prevents one has paid for a great deal of wraparound support.
The Fee-for-Service Trap in Mental Health Reimbursement
The flip side of the panel’s optimism was a blunt assessment of standalone behavioral health economics. Asked what kinds of companies she wished she saw more of, Lamont said the issue is rarely a shortage of mental health companies. “There are a lot of companies out there that are treating autism, that are treating substance abuse,” she said. “It’s really a matter of the financing.”
The structural problem is that fee-for-service mental health does not pay well, in a system already stretched thin. “If you’re just in the fee-for-service mental health business, that’s tough,” Lamont said. “You pay a mental health professional who I’m sure most feel are being underpaid for the work they do, and they’re getting a fee, and there isn’t a lot of distance between revenues and their income.” Her prescription was to apply infrastructure and AI to lower operating costs, since the clinical labor cost in a straight fee-for-service model leaves little room to build a durable business. The alternative, the one the panel kept returning to, is to stop treating mental health as a standalone line item and instead embed it in whole-person care where savings can be captured across the system.
This is also where the panel’s read connects to the broader behavioral health market. Mental health has been the most active subsector in behavioral health M&A, and ABA platforms continue to command premium valuations, but several panelists suggested that the providers built purely around fee-for-service volume face a harder long-term path than those positioned to share in outcomes-based savings. Chris Male, co-founder and managing partner of the Autism Impact Fund, put it in terms of where the winners emerge. “Those that have done it like George, you’re seeing really be defensible and sustainable businesses,” he said. “It’s hard, but if you do it, that’s the advantage.”
Medicaid Budget Pressure and the Push to Pay for Outcomes
If the panel had a prediction, it was that fiscal reality will accelerate the shift. Medicaid is under sustained budget pressure, and the panelists framed that strain less as a threat than as a forcing function. Boghos offered it as his single biggest prediction for the year ahead: “aligning what we’ve talked about, payment to outcomes instead of payment for volumes.” Some of that, he acknowledged, “is unfortunately because the current system’s not working and there’s budget cuts and Medicaid’s under pressure that we’re going to be forced to do that.” But he viewed it as an opportunity to better align what the system pays with what it gets.
Lamont was candid that the field has, if anything, drifted backward. “I feel like we’ve actually gone backwards in terms of paying for outcomes with people’s attitude towards value-based care,” she said, “but I think the reality of that is where we need to lean in.” She rejected the common objection that behavioral health outcomes are too hard to measure, arguing there are “so many ways to look at that in terms of somebody’s overall health.” The measurement question is a live one across the sector, where operators and payers alike acknowledge that outcomes measurement remains improvised even at sophisticated organizations, and where clinical leaders increasingly argue that standardizing what gets measured is the precondition for any outcomes-based payment model to function.
Male tied the threads together in the panel’s closing minutes, predicting the end of behavioral health as a standalone category and the rise of companies that treat the whole individual. “The payers know it’s not working,” he said. The bet across the table was that value-based care, written off in its Medicare Advantage incarnation, will find its most durable expression in exactly the place it was least expected: the complex, high-cost, behaviorally entangled populations of Medicaid, where aligning payment with outcomes is not just a philosophy but, increasingly, a budgetary necessity.
