Sorry, the value-based care takeover isn't happening.

For more than a decade, health care policy has pushed in one direction: away from fee-for-service (FFS) and toward value-based care (VBC). The Centers for Medicare & Medicaid Services has set ambitious targets for moving providers into accountable care arrangements, and much of the industry conversation has treated the shift as inevitable — a question of when, not if. CMS has even outlined a goal to move all traditional Medicare and most Medicaid beneficiaries into an accountable care relationship by 2030.

But not everyone agrees the transition will ever be complete. Critics of FFS argue the model rewards volume over outcomes and drives up costs without improving care, while advocates for VBC point to real gains — from improved chronic disease management to measurable savings. Yet despite the momentum, traditional fee-for-service models still dominate health care today, and the two payment structures often coexist in the same practices rather than one fully replacing the other.

So which model wins out in the long run? In this video, Dan D’Orazio, CEO of Sage Growth Partners, makes the case that VBC's rise has limits — and that predictions of its total dominance may be overstated. It's a perspective that runs counter to experts who make the case that value-based care represents the future of health care.