In the rapidly evolving landscape of U.S. healthcare, value-based care has become more than just an industry buzzword—it’s a critical framework for transforming how care is delivered, measured, and reimbursed. Yet, for many executives, clinicians, and patients alike, the concept remains mired in confusion, skepticism, and operational challenges. Why does value-based care matter now? Because with rising costs, increasing patient expectations, and a pressing need for better outcomes, organizations that can implement value-based strategies are poised to lead—not just follow—the next era of American healthcare.
That’s precisely why the story of Nancy Edwards, MBA, MHA, Founder & CEO of Edwards Value Based Healthcare, LLC, is both timely and essential. In this exclusive conversation, Nancy pulls back the curtain on what it takes to launch a value-based healthcare consulting firm in today’s climate, dispels persistent myths about value-based care, and offers a candid, pragmatic vision for aligning outcomes with what really matters: the patient. Whether you’re a senior executive, an early-career professional, or a student charting your path, Nancy’s insights make clear that value-based care isn’t just a policy—it’s a calling.
How does a childhood curiosity for science shape a career in healthcare leadership? For Nancy Edwards, it was the foundation of a lifelong journey.
Nancy’s early life in Decatur, Alabama, set the stage: “When other kids were playing with more traditional toys, I had a microscope and a chemistry set,” she shares. Driven by a fascination with science, Nancy majored in biology at Vanderbilt, setting her sights on medical school. Yet, she quickly discovered that a rigid lab-focused curriculum could lead to “medical students that were exhausted by the time they got to medical school.”
Recognizing the unsustainable trajectory, a friend proposed a pivot: Why not pursue the business side of medicine? Nancy did just that, graduating with a biology degree and completing her MBA—an unconventional but, as it turns out, prescient move. “That’s what I’ve always done… I’ve been fortunate enough to be in the management development program for several very large Pharma medical companies.”
But as the industry grew more complex, Nancy realized that an MBA alone wouldn’t suffice. “Healthcare was becoming too specialized… so I decided to go to George Washington and get an MHA,” she recalls. The combination of clinical insight, management acumen, and a thirst for continuous learning would define her approach—and later, her company.
What motivated Nancy Edwards to start Edwards Value Based Healthcare, LLC in late 2023? The answer is equal parts ambition, timing, and mission.
“I had always wanted to have a healthcare consulting firm, and so I decided now was as good a time as any to start the firm,” Nancy reflects. Despite only launching Edwards Value Based Healthcare, LLC in December, Nancy has already experienced a groundswell of support: “I’ve been so touched by the number of people that have reached out to me… about how can I help?”
Nancy’s consulting model is distinctive. Rather than confining her focus, she’s built a firm with two synergistic arms:
Value-Based Healthcare Certification & Consulting: Through partnerships like The Decision Institute and the Value Based Healthcare Center of Europe, Nancy offers Yellow and Green Belt training and consulting services, leveraging Michael Porter’s frameworks but advancing them with implementation-focused methodologies.
Medical Education and Industry Collaboration: Drawing on decades of experience in medical sales, marketing, and key opinion leader (KOL) management, Nancy’s second practice arm helps organizations strengthen medical education, society relationships, and industry-academic collaboration.
This two-pronged approach, she admits, is “very unusual… a lot of people are like, what, are you crazy? You can’t have a business that has two separate arms that way.” But for Nancy, it’s a necessary response to a complex, multifaceted industry.
What exactly is value-based healthcare—and why is it so misunderstood in the U.S.? Nancy doesn’t mince words: “There are so many different ideas about what value-based healthcare is, and so many of them have such negative connotations.”
For providers, it can evoke fears of “working harder for less reimbursement”; for patients, “they don’t have the access to care they’d like.” The narrative, she notes, is often fragmented and fraught with distrust.
Nancy’s definition is refreshingly direct: “Value-based healthcare is healthcare that focuses on outcomes that matter to the patient and their families… How can we design an efficient and effective system to deliver that care so that the outcomes are better and the cost is lower?”
Key features of Nancy’s approach to value-based healthcare:
Patient-centered outcomes: Prioritizing what patients and families care about most, not just what is easiest to measure.
Implementation frameworks: Utilizing proven methodologies (like those from the Decision Institute) that translate theory into practice—complete with certification for practitioners.
Integrated teams: Fostering collaboration across the continuum of care, not isolated episodes.
Does value-based care actually risk worsening patient care, as some fear? Nancy is clear: “When value-based healthcare is done correctly, it can deliver better outcomes and lower cost.”
She acknowledges, though, that transitions can be bumpy. Sometimes, introducing a value-based model—especially at the start—means adding team members or steps that “might initially raise your cost of care while you’re improving your outcomes.” But, she insists, the right systems will identify and eliminate inefficiencies over time, ultimately “course correcting so you get everything back on the right track.”
The essential ingredient? True collaboration. “If people are committed to working together… ideally, that’s what should result: better outcomes and lower cost.”
Where should payers (insurers) fit in the value-based healthcare journey? In Nancy’s view, U.S. healthcare has long struggled with this question.
Historically, providers and clinical teams developed new care models and approached payers only after proving better outcomes and cost savings. However, “more and more I’m hearing that the payers should be at the table earlier or at the beginning of the process.”
Why? Because waiting until after a new program is established often leads to payer rejection and stymied innovation. Nancy shares, “If they had involved payers earlier in the discussion… everybody could have been on the same page sooner.”
That said, she’s candid about the administrative burdens of earlier payer involvement—especially regarding paperwork and authorizations: “People are providing great care, but they didn’t do it according to the way they should have done it per the payer… That’s been one of the major issues.”
Nancy is optimistic that technology—including AI—can help bridge this gap by reducing documentation burden and streamlining approval processes. But the bottom line: payer-provider collaboration is essential, and the optimal timing is moving upstream.
How can healthcare leaders accelerate the shift toward effective value-based care? Nancy identifies three actionable priorities:
Education and Alignment: “One of the things I’m really committed to is doing as much education as I possibly can about what is value-based healthcare—the true definition and how it should work.” Nancy urges more conversations at ACHE, HFMA, and similar forums to build consensus and share best practices.
Technology Integration: While remote patient monitoring and AI hold promise, Nancy warns: “If you’re going to incorporate it, you need to do something with it… you need to incorporate it into your clinical care.” Information alone isn’t enough; actionable insights and governance are essential.
Stronger Governance: Healthcare systems must establish robust oversight for new technologies and practices to ensure responsible, effective use.
She summarizes, “The systems are beginning to realize that they really need early in the process some governance around these things… so we use technology responsibly and effectively.”
How can medical education and industry collaboration drive value-based care? For Nancy, this is both a personal passion and a professional imperative.
Her early experiences in teaching institutions fostered a deep respect for clinicians: “It really fostered my love for interacting with clinicians and understanding what they do and how they do it.” This led her to champion collaborations where clinicians, KOLs, and industry partners share research, disseminate innovation, and improve products through robust feedback loops.
Nancy believes that medical societies play a pivotal role: “By facilitating the interactions among the clinicians to stimulate improved care… working with industry to support the industry resources that can be provided in that area.”
For healthcare executives and educators, the lesson is clear:
Build authentic partnerships with clinicians and societies.
Invest in continuous professional development and evidence-based practice.
Support investigator-initiated trials and education that empowers practitioners at every level.
Do sales incentives undermine the integrity of patient care? Nancy’s answer is pragmatic and experience-based.
“I’ve never looked at it that way… there are people, without a doubt, that are in the industry to make a lot of money,” she concedes. But those driven solely by financial gain rarely last: “If your motivation is not to support the clinicians and the patients to give better care and have better outcomes, then you usually don’t last in the industry.” Clinicians, she observes, are savvy and demand partners who share their commitment to outcomes.
What sustains trust in these relationships? Nancy argues for authenticity: “You have to develop authentic relationships… you really have to earn it when you’re on the industry side.” She’s clear that patient trust is foundational, and transparency is non-negotiable.
Should only clinicians direct clinical operations, or is there room for non-clinical leaders? Nancy champions a multidisciplinary approach.
“One of the things that we really haven’t touched on yet with true value-based healthcare is that you do have an integrated practice unit… so obviously, clinical operations is something that is very strong in that delivery chain.”
She continues, “Someone with strong clinical operations that’s not clinical, if they have that operations expertise and they’re working as a team with the other clinicians… it’s really all about the team working together.”
The key: leverage each team member’s strengths, promote knowledge-sharing, and resist the urge to become a “jack of all trades.” “It’s important for someone to be a master of one thing and someone else to focus on being a master of another and working together.”
How does Nancy Edwards measure success for Edwards Value Based Healthcare, LLC? It’s about lasting impact, not just revenue or accolades.
Nancy’s benchmark is clear: “My goal is really to train as many people as I can on what is—what really is—value-based healthcare… and really have those conversations about how we can all work together.”
She draws energy from connecting with students, clinicians, and executives at conferences and society meetings: “It’s incredibly energizing for me… If I can use my efforts on the value-based healthcare side to do that education and facilitate those conversations, that’ll be successful.”
On the medical education side, her focus is helping organizations “support providing the right clinical information and clinical evidence to their clinicians” and ensuring KOL management drives both improved outcomes and innovation.
Ultimately, Nancy’s motivation is legacy: “I really… want to leave healthcare in a better state than when I started in this industry… it’s really always been my motivation in whatever job I have.”
The U.S. healthcare system’s transition to value-based care is a marathon, not a sprint. Nancy Edwards, MBA, MHA, and Edwards Value Based Healthcare, LLC, remind us that success depends on clarity, collaboration, and a relentless commitment to what matters most: patient outcomes. Whether you’re leading a health system, launching a new program, or preparing for your own Green Belt in value-based healthcare, remember Nancy’s parting wisdom—real progress happens when education, technology, governance, and authentic partnership align.
Actionable Insight:
If you want to drive value-based transformation in your organization, start with these steps:
Clearly define what value-based care means for your context.
Involve payers and key partners early in the process.
Invest in education, not just for clinicians, but for every team member.
Use technology as an enabler—not a replacement—for relationship-driven, outcome-focused care.
Measure success by the conversations you start and the people you empower.
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