Provider organizations caring for chronically ill populations under value-based care contracts with payers know the stakes: every contract, every patient group, and every year-end calculation carries real financial consequences. Health systems and medical groups are tasked not only with delivering holistic, high-quality care to vulnerable patients under value-based care contracts, but also with driving stronger financial performance across the entire population. Margins become narrow, contracts are becoming even more complex, and policy shifts this year keep raising the bar. Yet too often, executives are left making decisions without the visibility they need, and the result is millions in lost shared savings and missed opportunities to deliver better care to the patients who need it most.
Here are three of the most common ways providers lose ground in risk-based arrangements, and how executives can close the visibility gap with the right infrastructure in place.
1. Siloed reports conceal the true financial picture
Most provider organizations are buried under mountains of financial reconciliation reports and spreadsheets across Medicare Advantage, Medicaid, ACO REACH/MSSP, and Commercial contracts. A provider network with contracts across multiple states may receive hundreds of monthly files in a single year. Each report is sound for its individual market, but together they offer no easy way to answer the basic executive questions:
- Are we ahead or behind in our overall performance?
- Which markets or product lines are slipping?
- Do we need to redirect resources before year-end?
- Where should we concentrate our efforts so patients receive the most impactful value-based care interventions?
This fragmentation means leaders waste time harmonizing fragmented data across all payers and stitching financial reports together, while crucial opportunities to course-correct slip away. Without a single vantage point across all risk contracts, provider organizations burn time chasing spreadsheets while underperforming risk contracts quietly erode margins.
In 2025 and beyond, provider organizations are looking to build sustainable value-based care arrangements across every payer arrangement. The key is transforming today’s blind spots in utilization metrics into early signals, giving clinical teams the chance to intervene sooner and enabling executives to protect and strengthen margins.
2. Waiting months for claims data creates delayed reactions
In risk-based care, time is money in the most literal sense. Yesterday’s numbers are rarely enough to steer today’s decisions, yet many providers often wait months for claims data to finalize. Those lags force executives to make decisions with stale information and by the time those insights surface, the chance to intervene may be long gone.
When leaders cannot see real-time performance, they miss early warnings of rising utilization metrics, unfavorable MLR shifts, or population changes that demand rapid response. Without timely clarity, providers end up making decisions based on outdated data, unable to reallocate staff, adjust care management, or renegotiate payer terms in time. The result: deficits deepen and millions in shared savings opportunities go unrealized. The bigger cost is when patients who needed early interventions are overlooked, diminishing both care outcomes and trust in the model. With timely forecasts and live visibility, those same warning signs can become early signals to act, allowing executives to act quickly and protect margins before they erode.
3. Misaligned teams lead to wasted effort
Provider organizations often juggle data from hundreds of sources monthly, including medical and pharmacy claims, eligibility, financial files (MMRs, CCLF, PDE, Part D, Part B, ect.), and other payer files that don’t fit together cleanly. Finance interprets one story, clinical teams build another, and leadership is left to bridge the gap. Without a single source of truth, healthcare priorities splinter.
The cost is not just inefficiency. Misalignment drains focus, sending clinical teams to chase the wrong members and finance teams to rework reports that should already be reconciled. Without alignment, even well-intentioned patient interventions may fail to reach their value-based care goals.
What healthcare leaders need to change the trajectory
These aren’t small operational process flaws. They are systemic barriers that prevent provider organizations from fully succeeding under value-based care models. Executives have seen entire contracts swing from surplus to deficit simply because the right insights arrived too late, leading to millions of potential surplus lost. Without real visibility, even the strongest patient care strategies and operational plans cannot deliver the returns they should.
The path forward is not more spreadsheets or more reports, it is a new level of infrastructure where healthcare providers and payers can align on the same population they are both being evaluated on. Healthcare executives need a single vantage point across every contract, every line of business, and every market. That is the purpose of Arbital Health’s latest product launch, the Adjudication Dashboard: a centralized view that harmonizes fragmented healthcare data files, consolidates contract performance year over year across all lines of business, and provides year-to-date forecasts with actuarial-grade precision.
With that clarity, executives can move from reactive to proactive with a standardized platform that delivers real, actionable insights across multiple risk adjustment models. They can:
- Identify underperforming contracts before margins collapse
- Direct clinical and financial resources to where they matter most
- Negotiate from a position of strength
For organizations carrying the weight of complex risk-based care, visibility isn’t a nice-to-have, it is essential infrastructure for financial sustainability and better patient outcomes.
Arbital Health Adjudication Dashboard:
One Executive-Level View Across Entire Risk Contract Performance
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