COVID has strained our healthcare system, payors are feeling the squeeze of rising costs, and patients are bearing the brunt of the current system's shortcomings. As a result, healthcare is undergoing a transformation, from care that is predominately fee for service and based on volume of care to value-based care. Risk-based contracts are critical to building businesses based on risk and value, rather than fees and volume. We talked to digital health builders — from Firefly Health, Pearl Health, Waymark, Carrum Health, Eleanor Health, Patina Health, and BlueCross BlueShield of North Carolina — at the forefront of the shift to value-based care about how to build risk-based companies. *The spectrum of risk-based models [1:33] *Where we are in the shift to value-based care [3:37] *Deciding to go at risk [5:46] *Establishing partnerships [13:03] *Defining success [19:14] *Scaling [24:16] *Investor perspective [29:46] For more on building digital health companies: a16z.com/digital-health-builders.