What happens when you put a practicing nurse practitioner who is also a health care investor, a chief clinical officer who has led physicians for three decades, and a former federal health IT regulator on one stage?
At Navina Ascend 2026, Dana McCalley, Navina's VP of Value-Based Care, did exactly that with Meghan FitzGerald, Dr. Keith Fernandez of Privia Health, and Dr. Jacob Reider, former Deputy National Coordinator at ONC. In their ensuing conversation, they identified the forces that are shaping health care in 2026.
1. The era of polite optimism about value-based care is over
Asked to grade value-based care, the panel landed everywhere from a B to a failing mark. The bullish case, argued by FitzGerald, is that the model has done what it was designed to do and has simply lacked champions inside health systems; with cost pressure mounting and AI making data usable, "it's about ready to leave the harbor and hit some speed." The skeptical case, from Fernandez, applies a harder test: are outcomes better and total costs lower? At a national level, he argued, "it hasn't solved a problem, so I can't give it a passing grade."
What nobody disputed is that incentives remain fundamentally misaligned. Reider invoked the old axiom "no margin, no mission" to describe an industry still trying to serve patients' health while being paid, largely, for something else. CMS may be steering toward universal participation in value-based arrangements by 2030, but the maturity gap on the ground is vast: the same market contains organizations with sophisticated risk infrastructure and physicians signing their first Medicare Advantage contract who have never encountered an HCC.
2. AI's killer app is friction removal, not moonshots
The most grounded perspective on artificial intelligence came from Meghan FitzGerald. She located burnout not in the work of medicine but in the friction surrounding it: countless clicks per shift, dozens just to order a common medication. In her view, the highest-value AI puts actionable clinical, operational, and coding intelligence in front of the care team at the moment of the encounter, not in a retrospective report weeks later.
Her test for any AI tool was unambiguous: "AI only works if it's done through the lens of a clinician." Tools that hand a provider a bare diagnosis code without evidence fail that test. Tools that surface the full clinical picture pass it.
3. AI adoption is outrunning the rules that govern it
Dr. Reider, who helped write federal health IT policy, described a regulatory landscape that has not caught up to the latest technology. That said, states are beginning to experiment, with Utah now permitting carefully bounded AI programs, including prescription refills with no human in the loop. He argued these experiments are exactly how the industry learns where human oversight is essential and where it is not.
His framing captured the moment's paradox: the danger is not only in adopting technology too fast. Increasingly, there is also a cost in adopting it too slowly, because practicing without the latest technology may also raise questions of standard of care.
4. The unit of transformation is the team, not the physician
If there was one point of total consensus, it was that "primary care is not a physician's job," as Dr. Reider counter-intuitively argued. It belongs to the whole team, from nurses and MAs to social workers and physical therapists, who are often better than physicians at the behavior-change work that drives chronic disease outcomes.
Dr. Fernandez offered the proof point from Privia Health: restructuring practice meetings around the entire care team, and investing in physician governance and clinical leadership development, changed retention, culture, and performance more than any single technology decision. It was Privia's physician advisory council, notably, that drove the organization's adoption of Navina. His conclusion: "there is something big for culture in changing the world, just with the people you're around."
The moment in front of us
Asked what she'd change about value-based care, FitzGerald cited the incentives, and, only half-jokingly, the name itself. After two decades, she argued, value is just the price of entry. Healthcare moves slowly but the forces now converging, from AI at the point of care to consumerism to economic pressure, are exactly the kind that break incumbency.
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