With the shift from fee-for-service to value-based payment accelerating, most healthcare finance leaders are focused on adopting and operating risk-based reimbursement models for medical services. A variety of reimbursement arrangements are at play, including bundled payments accountable care organizations, shared savings programs, MACRA, and directto-employer health plans. To succeed in this business model shift, health systems, hospitals, and physician practices face daunting challenges to develop the essential competencies required to manage risk-based contracts with government and commercial payers. These competencies range from assessing risk in patient populations and risk-based payment models to containing clinical risk through patient engagement strategies.