Powering Value-Based Care with Clinician-Led, Patient-Centered Design: The MyHealth Bundles Program

Value-based care has long been championed for its potential to align clinical outcomes with financial incentives, but many health systems struggle to implement truly transformative models. Fee-for-service constraints, payer fragmentation, and complex claims processing often limit progress to incremental gains rather than transformation to true value-based arrangements. Herein, the authors present an innovative approach to bundled payments that overcomes many of these hurdles by placing physicians and patients at the center of the redesign process while partnering with self-insured employers. The Vanderbilt University Medical Center MyHealth Bundles program rethinks traditional specialty care episodes through prospective bundled payment arrangements. Rather than layering risk contracts on existing workflows, clinicians are encouraged to envision an ideal care model without the usual fee-for-service rules, prior authorization requirements, or utilization management barriers. This physician-led design then becomes the blueprint for new financial models that take full two-sided risk on common high-cost clinical episodes, such as maternity care, weight loss, and joint replacement. In each instance, the bundle is built around everything a patient needs, from diagnosis to recovery, with the health system assuming accountability for outcomes and utilization throughout that period. One of the most significant innovations is bypassing conventional payer contracts in favor of direct partnerships with employers, many of whom face escalating health care expenditures and seek practical strategies for improving employee health. To address operational complexities inherent in prospective risk-based billing, Vanderbilt University Medical Center collaborated with a specialized third-party administrator to develop claims processing models capable of bundling and adjudicating diverse services under a single invoice. This arrangement helps overcome the structural challenges that often impede new payment models within traditional insurance pathways. Early outcomes suggest meaningful benefits for all stakeholders. Employers benefit from transparent and predictable costs, while patients experience significantly reduced or eliminated out-of-pocket expenses, enhanced care coordination, and more convenient clinical pathways. At the same time, clinicians report greater autonomy and alignment of financial and professional incentives. Preliminary data also point to improved clinical metrics, such as lower cesarean section rates in maternity bundles and decreased need for joint replacement surgeries in orthopedic bundles. By illustrating how prospective bundles, direct contracting, and patient-centered service design can be integrated into a comprehensive value-based care strategy, the MyHealth Bundles program offers a replicable framework for other institutions. Rather than serving as a niche alternative, this model represents a viable pathway for health care systems intent on transcending transactional approaches and moving toward truly transformative value-based care.