Value-Based Care in Wound Care: The Idea Everyone Loves and the Reality Few Are Ready For

The push toward value-based care in wound care is accelerating, but many of the loudest conversations are skipping over the hardest truths.

Everyone agrees value-based care is the future

Right now, value-based care is being positioned as the inevitable next step for wound care. With reimbursement tightening, utilization under scrutiny, and margins shrinking, the industry is being nudged toward “full cycle” payment models that promise alignment, efficiency, and better outcomes.

On paper, it sounds progressive.

In practice, it raises a question many are avoiding:

Are we ready to be held accountable for outcomes we do not fully control?

Chronic wounds are being treated like tidy episodes, and they are not

A core assumption behind value-based care is that a clinical episode has a defined beginning, a defined end, and a relatively predictable pathway. Chronic wounds violate all three assumptions.

Wounds are not diagnoses. They are symptoms of systemic disease. Diabetes, vascular disease, renal failure, malnutrition, immobility, and social factors drive outcomes as much as clinical intervention. Healing timelines vary wildly. Recurrence is common. Complications reset the clock.

Trying to force chronic wounds into a clean episode-based model does not simplify care. It distorts it.

Accountability without control is not value-based care

Many proposed wound care value models quietly ignore a central issue: attribution.

• Who owns the outcome when vascular access is delayed?

• Who absorbs risk when offloading fails at home or in a facility?

• Who pays when a patient is readmitted for reasons unrelated to the wound itself?

Wound care providers are often expected to accept financial risk while lacking authority over referrals, imaging timelines, home health execution, DME, nutrition, or skilled nursing facility protocols. That is not accountability. That is exposure.

Payers are skeptical, and they are not wrong

There is frustration among providers about payer reluctance to embrace full-cycle wound reimbursement. But payer skepticism did not appear out of nowhere.

Rapid spending growth in advanced wound modalities, inconsistent utilization patterns, and wide variation in clinical protocols have made payers cautious. Without standardized pathways, severity adjustment, and auditable outcomes, full-cycle payment looks less like value and more like a blank check.

The uncomfortable truth is that parts of the wound care industry contributed to this trust gap.

Value-based care is not failing, but the narrative is flawed

The industry keeps asking, “Why won’t payers pay for the entire wound journey?”

A better question might be, “Have we clearly defined the journey?”

True value-based care requires discipline. Clear pathways. Risk stratification. Real outcomes data. Guardrails that protect patients and payers at the same time. Most importantly, it requires acknowledging that not every wound, provider, or setting belongs in a bundled payment model.

Pretending otherwise slows progress.

Where value-based wound care is actually working

What is working looks very different from what is being marketed.

• Narrow cohorts with defined clinical characteristics

• Performance-based incentives layered on top of existing payment models

• Partnerships with ACOs and MA plans that already manage total cost of care

• Programs focused on reducing admissions, amputations, and site-of-care inefficiencies

These approaches respect complexity instead of ignoring it.

A necessary reset

Value-based care in wound care is not a bad idea. It is an unfinished one.

The next phase will not be driven by slogans or pressure to “get into value-based care.” It will be driven by organizations willing to admit what they control, what they do not, and what outcomes they can realistically stand behind.

The conversation is uncomfortable because it should be. Progress depends on honesty, not enthusiasm alone.

At Kindling, we believe the future of wound care reimbursement will reward those who build real infrastructure before taking on real risk. Anything else is noise.

---Nikki Johnston, Founder