As state and federal agencies double down on payment reform, all-payer and total cost of care (TCOC) models are gaining traction as vehicles for containing cost growth, improving outcomes, and reducing disparities in care. But while the vision is bold, execution remains complex—and success demands more than policy design.
In a panel discussion hosted by Pearl Health, two of our 2025 Top 50 Value-Based Care Thinkers—Jessica Moschella, SVP of High-Value Care at the University of Vermont Health Network, and Stephen Rosenthal, SVP of Population Health Management at Montefiore Health System—shared lessons from the front lines. Moderated by Pearl’s Chief Clinical Officer, Dr. Dennis Weaver, the conversation offered a candid look at what it takes to lead through payment transformation—and through the operational, cultural, and clinical shifts required to make it meaningful.
5 Key Takeaways
All-Payer and TCOC Models Offer Simplicity—But Demand Alignment
“You want to limit the variable of who is paying for the care and incentivize providers to manage patients—not contracts.”
Stephen Rosenthal
SVP of Population Health Management
Montefiore Health System
Both panelists underscored how all-payer models reduce fragmentation by creating consistent incentives across Medicare, Medicaid, and commercial payers. Rather than negotiating dozens of arrangements with mismatched quality metrics and reporting requirements, health systems can orient around a shared objective: improving population health.
When paired with a total cost of care model—often through global budgets—this structure enables providers to reinvest in care management, redesign delivery workflows, and build the infrastructure required for long-term sustainability.
Care Coordination Is the Cornerstone of Value-Based Care
“If you get care coordination right, we can break out of fee-for-service.”
Jessica Moschella
SVP of High-Value Care
University of Vermont Health Network
Even the best-designed payment models won’t drive impact without robust care coordination. For patients with complex needs—multiple chronic conditions, social risk factors, or limited access to services—fragmented care often leads to avoidable deterioration and high-cost utilization.
Both leaders emphasized that building team-based, community-embedded care models is critical to success. It requires more than workflow redesign—it demands a new definition of accountability that extends beyond the visit, empowering providers to manage the full continuum of care.
Urban and Rural Systems Face Different Barriers—But Similar Pain
While the UVM Health Network and Montefiore serve vastly different regions, both contend with workforce shortages, data silos, and geographic access challenges. In Vermont, that may mean managing care across mountains, lakes, and broadband deserts. In the Bronx, it may mean navigating traffic gridlock, housing insecurity, and limited home-based service capacity.
“Whether you’re crossing a lake by ferry or stuck in traffic trying to get across a bridge, the challenge is the same: getting the right care to the right patient at the right time.”
Jessica Moschella
SVP of High-Value Care
University of Vermont Health Network
The takeaway? Success in value-based care doesn’t come from rigid models. It requires adaptable strategies, local partnerships, and flexible infrastructure—tailored to community needs.
Technology Alone Won’t Solve the Problem—But It’s Essential
“If you don’t understand the population you’re confronting, you don’t know how to create the resources you may need to have an impact.”
Stephen Rosenthal
SVP of Population Health Management
Montefiore Health System
Both leaders agreed that data is foundational to population health—but only when paired with the workflows and culture to act on it. Many organizations still struggle with basic interoperability, risk stratification, and real-time performance visibility. But even when the tools are in place, success hinges on leadership, team buy-in, and shared understanding.
“We’ve placed the burden of fixing healthcare on value-based care. A payment model can’t solve everything—it has to be part of a broader ecosystem.”
Jessica Moschella
SVP of High-Value Care
University of Vermont Health Network
To move beyond fee-for-service, organizations must rethink how teams collaborate, how decisions are made, and how success is defined.
AI and Predictive Analytics Will Power the Next Phase
“AI lets us finally start predicting and preventing—not just reacting.”
Stephen Rosenthal
SVP of Population Health Management
Montefiore Health System
From pre-disaster outreach to early disease detection, both systems are beginning to use artificial intelligence and predictive modeling to deliver more proactive care—especially for patients who are traditionally underserved.
Jessica highlighted innovations like drone medication delivery in remote areas and automated outreach during severe weather events. Stephen described using AI to flag early cancer signals in imaging results and lab data—years before a formal diagnosis.
For these leaders, the future of value-based care depends on making technology not just a tool for efficiency, but a platform for personalized, anticipatory care.
Final Thought: Value-Based Care Is the Right Thing to Do
“This isn’t just about reimbursement reform. It’s about designing care systems that actually work for patients.”
Jessica Moschella
SVP of High-Value Care
University of Vermont Health Network
Despite years of effort to build new models, realign incentives, and scale population health infrastructure, fee-for-service still dominates much of the U.S. healthcare system. But as Stephen and Jessica made clear, the organizations that commit to long-term investment—operationally, clinically, and culturally—will be the ones that help shape the future.
