In the value-based scenario, scale is not nearly as important as in fee for service. While it still helps in some ways (e.g. for investing in tech platforms), it’s no longer the primary basis of competition. So in shifting to a value-based arrangement, much of the incumbents’ advantage is reduced.
reflecting on how all my life it seemed like there was such a tremendous emphasis on the value of being cerebrally clever, and yet how all of the really wicked problems I’ve had + I’ve known people around me to have had, have come from incompetence with emotions, below the neck
My advice that I'd go to jail for (provided anyone would listen to me) is "let's focus our energies on fixing the old corrupt systems rather than tilting at the windmills of eliminating the bad people." Efforts to fix bad people always get lots of supporters, but never seem to get any actual positive results.