ABSTRACTValue‐based health care (VBHC) is an evolving paradigm in healthcare that prioritises patient outcomes relative to the costs incurred. VBHC emphasises efficiency, quality, and patient satisfaction as metrics and determinants of healthcare. A VBHC approach is becoming increasingly significant as healthcare systems worldwide grapple with rising costs, staff shortages, and the ongoing need for improved patient care. Online adaptive radiotherapy (oART) is a promising innovation in radiation oncology, allowing for the adaptation of radiation treatment plans to account for daily anatomical changes. This innovation has the potential to improve patient outcomes; however, it requires investment in the technology, manpower, and training to deliver an adaptive radiotherapy service. This commentary aims to explore the role of radiation therapists (RTs) in oART, using RT‐led workflows within the context of the broader models of care that involve radiation oncologists and multidisciplinary teams. This commentary also aims to highlight the potential benefits and challenges of adopting an RT‐led approach within VBHC principles, focusing on key themes such as treatment accuracy, patient satisfaction, training, and cost implications.