> ## Content Index > Fetch the complete content index at: https://agility.nexcurve.com/llms.txt > Use this file to discover other available public pages before exploring further. # Signal: The Contract Era is Dead. - URL: https://agility.nexcurve.com/signal-the-contract-era-is-dead/ - Published: 2026-01-13T12:00:00.000Z - Updated: 2026-09-03T17:10:07.000Z - Description: The Joint Operating Model Era Has Begun - Author: Michael A. Eaton - Tags: Payer-Provider, Payer Leaders, #SIGNAL, #Import 2026-09-02 14:21 Here’s the signal that matters: > **If payers and providers don’t share an operating model to deliver the access members they thought they bought at a premium they can afford, you don’t have a strategy. You just have unit cost negotiations.** --- ### Executive Takeaway If you want to reduce premiums to create meaningful market advantage (by \~20%) without hollowing out access or cratering hospital and physician margins, the path is not a better contract. It’s a shared provider–payer operating model that can do three things at once: 1. Guarantee access to high-value care 2. Eliminate wasteful administrative friction 3. Apply value rules at scale to reduce low-value care That’s the play. And it’s bigger than cost. Done well, this becomes a platform for commercial HMO attribution growth, self-funded employer expansion, and scaling in Medicare risk. --- ## What It Means Most provider–payer relationships still run on the same old rhythm: the contract becomes the main event, and everything else becomes crisis management. You negotiate rates, debate risk, and escalate. Then you spend the next ten months watching access degrade, friction grow, and total cost drift. That model is breaking, not because people are less collaborative, but because contracts don’t create access, don’t remove friction, and don’t reduce waste. Here’s the new credibility test in the market: “coverage” must equal care. Employers and consumers aren’t buying networks. They’re buying access. And “network adequacy” language won’t survive the next cycle if people can’t get timely primary care, behavioral health, or post-discharge follow-up. This is why commercial HMO attribution is becoming a strategic wedge. Attribution isn’t the destination. It’s the proving ground where payers and providers can build shared accountability and consistent execution. When it works, it becomes the platform to win self-funded employers and scale into Medicare risk. > **What to Remember:** Attribution is where you prove the model. Employers are where you grow it. Medicare is where you scale it. --- ## The Strategic Move It Suggests Build a joint operating model outside the contract with authority, cadence, and accountability. Not a committee. Not a dashboard. Not a “partnership” press release. If the operating model can’t execute three moves simultaneously, it won’t bend cost *and* preserve access. **First: Guarantee access to high-value care.** Start with a defined “high-value set”—primary care continuity, behavioral health access, chronic disease management, maternity/newborn care, post-discharge transitions, serious illness support. Then operationalize it with measurable standards: patients seen within X days, authorizations decided within Y hours, follow-up within Z days, and real availability reporting. > **What to Remember:** If access isn’t measurable, it isn’t guaranteed. > **Second: Eliminate wasteful administrative friction.** Friction consumes clinician capacity and drives cost. Reduce prior authorization where evidence is clear. Publish criteria, standardize workflows, and gold-card high performers. The goal is to automate routine approvals, track peer-to-peer patient movement, appeals, and turnaround time, and actually reduce them. > > **What to Remember:** Friction is a cost structure. Treat it like one. > **Third: Apply value rules at scale with defensible logic.** Durable savings require reducing low-value care, but only if the rules can survive scrutiny. That means jointly endorsed targets, clear criteria and exceptions, patient-friendly explanations, fast appeals, and continuous monitoring for unintended harm. > > **What to Remember:** The rules don’t have to be popular. They must be defensible. --- ## How to Use It in the Room Where Decisions Get Made If you want to move this from concept to executive action, ask three questions and insist on answering them from both payer and provider perspectives: 1. What high-value services are we willing to guarantee access to—and what are the metrics 2. What friction are we eliminating this quarter—and how will we measure it? 3. What value rules are we aligned on to reduce low-value care—with criteria, exceptions, and monitoring? If you and your payer partner do not have clear answers, you likely have parallel strategies on affordability and access and a contract rather than a shared vision and operating model. Be the leader that invites an effort to drive serious (and sometimes uncomfortable) payer-provider conversations that are different from performative contracting theater. Create a joint governance body authority to enforce standards, reduce friction, refine rules, publish results, and course-correct quickly when unintended consequences emerge. > **What to Remember:** A contract without governance is a deal. A contract with governance becomes a operating system to give people the care they thought they bought at a price they can afford. --- **J. Michael Eaton** — SVP, Healthcare Strategy, Nexcurve *Agility by Nexcurve.* Articles, analysis, research and relationships for healthcare leaders building a professional legacy through transformation.