Value-Based Care Was Designed to Prevent This: So Why Are Measles Outbreaks Rising?

By Jordan C. Kabins, Ph.D., MBA

Introduction

Value-Based Care (VBC) was established to reduce costs, promote preventive care, and improve clinical outcomes by aligning incentives with long-term health rather than service volume. The central premise is that prioritizing prevention and rewarding outcomes will lead to a decline in avoidable diseases. However, the resurgence of measles, which has intensified through 2025 and into 2026, challenges this assumption. Measles is one of the most preventable infectious diseases in modern medicine, yet its return signals a deeper systemic issue.

The Preventable Problem

The MMR vaccine is highly effective, low-cost, and widely accessible, making measles outbreaks largely preventable when vaccination coverage remains stable. Over the past decade, however, MMR vaccine uptake has steadily declined, reducing herd immunity and increasing population vulnerability (CDC, 2026). As vaccination rates decrease, outbreaks become inevitable, leading to increased hospitalizations and a greater strain on healthcare systems, outcomes that VBC is specifically designed to prevent.

Where the Model Breaks Down

The primary limitation of VBC is not its emphasis on prevention, but rather the assumption that incentivizing providers will automatically lead to changes in patient behavior. Vaccination decisions are shaped by beliefs, trust, perceived risk, and social dynamics, as outlined by Social Cognitive Theory, rather than by clinical recommendations alone (Bandura et al., 1999). While healthcare systems can measure vaccination rates and associate them with provider performance, they are less equipped to address the behavioral and cognitive factors that ultimately influence patient vaccination decisions and provider actions (Kabins, 2026).

The Clinical Reality

Clinicians encounter significant constraints that limit their ability to influence patient behavior. Short appointment durations, competing clinical priorities, and increasing administrative burdens reduce opportunities to address vaccine hesitancy comprehensively. Explaining vaccine safety, countering misinformation such as the false association with autism, and emphasizing the necessity of multiple doses require both time and trust; resources are often lacking in standard care delivery models. As a result, providers are expected to achieve outcomes dependent on behavioral change without sufficient structural support or time. This raises a critical question: Are providers adequately equipped with the training and tools to influence patient behavior and promote the adoption of preventive measures, such as the MMR vaccine?

The Incentive Gap

A critical issue within VBC is that incentives are primarily directed at providers, while patient behavior and emerging risk trends remain insufficiently addressed. Declining uptake of the MMR vaccine was evident in the data over the years, highlighting the need for earlier, more targeted intervention. However, there was little evidence of meaningful incentive adjustments or system-level responses to increase vaccination before outbreaks occurred. This pattern indicates that VBC, as currently implemented, functions as a reactive system, tracking outcomes without consistently acting on early indicators of risk. If data clearly demonstrated declining vaccination rates, stronger and proactive incentives should have been implemented to increase MMR uptake before measles cases began to rise, because measles outbreaks lead to higher medical costs for everyone.

Cost Implications

When preventive measures fail, the financial consequences are immediate and substantial. Measles outbreaks lead to increased emergency department utilization, hospital admissions, and extensive public health interventions such as contact tracing and isolation protocols. These expenditures far exceed the minimal costs associated with vaccination, highlighting a fundamental inefficiency within the system. A preventable condition can therefore escalate rapidly into a significant financial burden, directly contradicting VBC's primary objective of reducing unnecessary healthcare spending.

Where VBC Needs to Evolve

To address these gaps, VBC must evolve beyond static incentive models and incorporate behavioral strategies into its provider framework (Kabins, 2026). Contracts should become more dynamic, enabling timely responses to emerging public health trends such as declining vaccination rates before outbreaks occur. Integrating behavioral science into care delivery would enable systems to actively influence patient decision-making rather than simply measure outcomes. Additionally, greater accountability in data utilization is necessary, shifting from retrospective reporting to proactive intervention when early warning signs are identified.

Conclusion

The resurgence of measles is not solely a public health issue; it indicates that, while value-based care is conceptually robust, it is not yet fully equipped to drive the behavioral change necessary to achieve its objectives. Although VBC was designed to reduce costs, improve outcomes, and promote prevention, these goals remain incomplete without addressing the underlying factors influencing patient decision-making. The solution is not to abandon VBC, but to strengthen it by integrating behavioral insights, enhancing responsiveness, and aligning incentives with both provider actions and patient behavior.

Reference:

Bandura, A., Freeman, W. H., & Lightsey, R. (1999). Self-efficacy: The exercise of control

Centers for Disease Control and Prevention. (2026). Measles cases and outbreaks. Centers for Disease Control and Prevention. https://www.cdc.gov/measles/data-research/index.html#cdc_data_surveillance_section_5-yearly-measles-cases

Kabins, J. (2026). The Challenges and Experiences of Mask Compliance among Nurses in Southern Nevada during COVID-19.