Why ACOs Should Embrace the Value-Based Enterprise Model — Now

The shift from volume to value isn’t coming—it’s here. And with CMS’s Transforming Episode Accountability Model (TEAM) set to go live in 2026, ACOs have a unique window to align care, mitigate risk, and expand impact across their entire ecosystem.

The opportunity? Forming or joining a Value-Based Enterprise (VBE).

The urgency? TEAM’s mandatory bundled payments—with financial consequences for those unprepared.

Let’s break down why VBEs are quickly becoming essential for ACOs—and how they can unlock success under TEAM, MSSP, and beyond.

Why Now?

TEAM will impact over 700 hospitals starting January 2026. Early modeling indicates that 62% of hospitals could lose money under TEAM without proactive alignment strategies.

Meanwhile, many ACOs are still operating in silos—especially when it comes to hospitals and specialists. That’s no longer sustainable.

The solution? A VBE model that unites primary care, hospitals, and specialists under one value-based framework—without needing to build a new legal structure from scratch.

What Is a Value-Based Enterprise (VBE)?

A VBE is a strategic framework that brings providers together to coordinate care, share financial accountability, and legally align incentives.

Depending on the model created, a VBE can unlock:

• Flexibility in how physicians are compensated

• Legal protections through Stark Law exceptions and Anti-Kickback Statute safe harbors

• Streamlined ability to offer bonuses, shared savings, and referral alignment

• A scalable vehicle for collaboration under TEAM, MSSP, and other APMs

VBEs aren’t theoretical—they’re actionable. And they’re built to support what ACOs are already trying to do: deliver better care, at lower cost, across diverse care settings.

The ACO Advantage

ACOs already excel in primary care coordination and population health. But many still struggle to bring specialists and hospitals into the fold.

VBEs allow ACOs to:

• Create shared clinical and financial accountability across the continuum

• Offer real-time consults and care coordination with specialists

• Align post-acute partners with shared outcomes, not just referrals

• Build scalable specialist networks aligned with ACO performance goals

  
  

In short: VBEs help ACOs go from isolated excellence to systemwide success.

A Win-Win for Hospitals and Specialists

Under TEAM, some hospitals face up to $4 million in downside risk for episodes like joint replacements and coronary bypasses. That kind of exposure demands alignment.

VBEs create the structure for:

• Shared protocols to reduce variation

• Standardized care pathways that lower readmissions

• Joint incentives that turn fragmented care into coordinated performance

  
  

For specialists, VBEs offer predictable compensation, a seat at the strategy table, and fewer administrative hurdles compared to traditional contracts.

Getting Started: 3 VBE Use Cases

Depending on your readiness, VBEs can scale:

1. Care Coordination Models – Start small with collaborative care and shared goals

2. Partial Risk Models – Align upside/downside risk across multiple provider types

3. Full Risk Models – For mature organizations managing total cost of care across episodes

   
   

Every step toward integration builds the muscle you’ll need to succeed under TEAM and beyond.

Final Thought: Don’t Wait for 2026

TEAM is mandatory. MSSP is evolving. And the policy levers are in place.

The smartest ACOs aren’t reacting—they’re leading.They’re building VBEs now to unify hospitals, specialists, and PCPs under one value-based mission.

VBEs are flexible.They can work within your existing structure.And they’re the clearest path to success under TEAM.

👉 Ready to explore a VBE for your ACO or TEAM hospital participant?

• Join TEAM Connect – Free for hospitals and ACOs

• Watch the TEAM Connect recorded webinar and slides about VBEs presented by Anthony Long and Jim Yanci from Pinnacle. The webinar shares powerful insights on how VBEs can streamline alignment across diverse organizations to thrive in value-based care.

• Let’s connect and discuss how your organization can take the first step.