Strategic Survey Q1 2019: Defining Risk


In 2019, the U.S. healthcare market is poised to continue its march towards value-based care. In the context of increasing financial pressure and the prioritization of quality improvement, risk contracting provides health systems an opportunity to manage the total cost of patient care. Through risk assumption, clinically integrated networks are able to align quality and care coordination with cost containment and thereby deliver value to their communities.

In this special topic report, The Health Management Academy (The Academy) seeks to quantify participation in risk-bearing arrangements and understand the strategic prioritization of risk among Leading Health Systems (LHS).


In February 2019, The Academy conducted the eighteenth round of phone interviews for its quarterly strategic survey among LHS executives, including: CEOs, COOs, CFOs, CMOs, CNOs, and CSOs.

The survey for the interview consisted of:

  1. A tracking section that provides insight into trends around primary strategic areas; and
  2. A special topic area that allows for an in-depth look into a timely developing issue.

Key Findings

  • Definition: Health systems view risk and value-based care as separate but complementary. Risk is a construct for managing the premium dollar and a key mechanism by which they can deliver value to their communities.
  • Prioritization: Despite any limitations posed by regional market dynamics, 54% of health systems place a high priority on growing their risk portfolio. Moreover, 64% anticipate that the number of lives covered under such arrangements will grow in 2019
  • Preparedness: Health systems’ participation in risk arrangements is generally proportional to their preparedness for taking on risk. While 86% of health systems report having centralized oversight of these arrangements, the robustness of operational support seems to increase along with participation.