Four in 10 employers have not linked any of their medical spending to value-based payment models, highlighting how slowly value-based care has expanded in the commercial market despite years of industry focus, according to a 2026 EY report published Sept. 24.
Eight things to know:
1. Value-based care adoption remains limited in the commercial market. Forty percent of employers said none of their medical spending is tied to value-based or at-risk arrangements. Another 27% said less than 10% of spending is tied to those models, while 22% said 11% to 30% is. Just 3% said more than 31% of their medical spending flows through value-based arrangements.
2. Commercial value-based care has struggled to scale like Medicare. EY pointed to market fragmentation, employee churn, misaligned incentives and provider economics that still depend heavily on commercial reimbursement as key barriers.
3. Specialty-specific models are the most common form of value-based care among employers. Thirty-two percent reported using arrangements focused on areas such as oncology or musculoskeletal care. Advanced primary care or primary care capitation was used by 21%, followed by bundled payments at 19%.
4. Healthcare affordability is a major pressure point. Forty-six percent of respondents said employee-paid premiums are workers’ top health benefits concern, while 18% cited copays and deductibles. Rising medical costs were employers’ most frequently cited benefits pain point.
5. Employers are shifting toward more targeted value strategies. EY said the commercial market is moving away from broad population-level risk and toward condition-specific programs, bundled episodes, care navigation, alternative sites of care and curated provider networks.
6. More than half of employers are steering workers to lower-cost settings. Fifty-six percent said they encourage use of alternatives such as telehealth and home health. Half said they shift additional costs to employees and 50% offer health and wellness incentives.
7. Employers are taking a more active role in value-based care design. EY said companies are increasingly moving beyond being passive purchasers and are instead curating networks, selecting high-value providers and targeting conditions where outcomes and savings can be measured more quickly.
8. Providers may face greater pressure to prove performance at the service-line level. EY said future commercial value-based networks are likely to emphasize outcomes, cost variability and patient experience, with condition-specific performance becoming more important than systemwide scale alone.
Click here to access the EY report.
