Will the destruction be creative?

The leading nursing home operator in the United States is Genesis Healthcare with nearly 400 facilities and is also a provider of a number of ancillary services (more on that shortly). In 2019, revenues were $4.6 billion and after a handful of years of significant operating losses ($1.8 billion cumulatively for four prior years), pretax income was ... See more

Because the market size of total creators who can potentially monetize through non-ad-based means is uncertain and appears small, and because direct user payments represent a lower-margin business than advertising (Patreon’s take rate starts at 5%, whereas ad-based platforms often keep 100% of ad revenue), incumbents are not incentivized to iterate... See more

Those are promising signs. On the other hand, the fundamental economics of the value-based arrangement still aren’t clear. If fee-for-service turns out to more profitable for both payer and provider, then value-based care won’t survive outside of Medicare Advantage. And there have been failures in the past, as cited above.