Kempton Presley, CEO of AdhereHealth, has expertise in health economics, analytics, digital health integration and value-based care.
In business, as in life, it’s easy to make commitments. It’s harder—and far more powerful—to stake your success on delivering them.
That’s the essence of going at-risk: tying your compensation directly to the results you produce. In healthcare, where the stakes are measured in both dollars and medical outcomes, it’s a model that’s redefining how partners work together across the industry.
For example, say a patient undergoes knee surgery to relieve chronic pain. The surgeon performs the procedure within a facility, each entity submits a bill and the insurance company pays. Under the traditional fee-for-service model, that’s where the story ends. In many cases, it doesn’t matter if the pain is gone or if the patient still struggles to walk six months later. Payment is tied to the service, not the outcome.
Value-based care is changing that equation—rewarding providers for quality and real-world results rather than volume. And increasingly, that same principle is extending beyond health plans and physicians to pharmaceutical companies, digital health firms and other partners across the healthcare continuum.
The model? Go at-risk—linking payment directly to the value delivered to patients. When you do, you’re not just promising results. You’re betting on them.
Beyond Providers: How At-Risk Models Are Spreading
In pharma, outcomes-based contracting ties a drug’s reimbursement to its effectiveness in real-world use. If it meets agreed-upon clinical targets—say, lowering cholesterol or controlling blood sugar—the manufacturer is fully paid (or even earns a bonus). If not, the company may issue a rebate or cover the cost of additional treatment.
In health technology, the same principle is at work, though the contracts are entirely separate.
For example, our company takes best practices from other at-risk models and ties our compensation to discrete, measurable behavior changes. These atomic human actions form the recipes for medication adherence improvement and clinical risk reduction, often within vulnerable patient populations. While we aren’t in risk-sharing agreements with manufacturers, our work directly influences whether a therapy achieves its intended results in the real world.
A drug may be covered under an at-risk arrangement between a manufacturer and payer, but its success often depends on separate adherence-focused partnerships like ours that address the social, behavioral and logistical barriers that can derail a treatment plan. Given that 40% to 50% of patients with chronic conditions don’t take their medications as prescribed, closing that gap can make the difference between a drug that delivers its full value and one that falls short.
Across different corners of healthcare, the details of the contracts may differ, but the principle is the same: Tie payment to performance, and you create a powerful incentive to deliver better results.
Why At-Risk Payments Make Business Sense
The appeal of at-risk models isn’t just about advancing a higher mission. It’s practical. I’ve found that organizations that embrace them are often rewarded in ways that go far beyond the contract itself:
• Aligned Incentives: When payment is tied to results, it encourages both sides to define success upfront. This can lead to shared goals, transparent expectations and fewer disputes later.
• Fueling Innovation: When standing still means losing revenue, organizations are motivated to find efficiencies, invest in better tools and refine processes. For example, my company’s at-risk adherence work has led us to invest in advanced predictive analytics, behavioral science and omnichannel engagement—all to ensure we deliver on what we promise.
• Building Trust: Putting “skin in the game” signals confidence in your ability to deliver. It can also set you apart from competitors and foster long-term partnerships built on mutual success.
Of course, the very qualities that make at-risk models so powerful also make them demanding. With financial outcomes tied directly to performance, there’s little margin for error—and success often requires a level of preparedness, precision and partnership that goes well beyond standard contracts.
Navigating The Risks
Going at-risk isn’t a leap you should take without preparation. It requires clear, objective measurement to avoid disputes; strong data infrastructure to track progress and validate results; and careful partner selection to ensure both parties can act on insights and stay committed when challenges arise.
The stakes are high: Misaligned metrics, poor data or the wrong partner can turn a promising at-risk model into a costly setback. In healthcare alone, failures to deliver on at-risk arrangements can mean not just lost revenue, but also diminished patient outcomes—impacting star ratings, reimbursement and ultimately, lives.
At its core, going at-risk requires making a shift in your leadership mindset. I’ve found that moving from “We’ll try to deliver value” to “We only succeed when we deliver value” can create accountability, spark innovation and strengthen relationships. In healthcare and beyond, I believe the question isn’t whether at-risk models work—it’s whether organizations possess the collective confidence, wisdom and expertise to bet on themselves.
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