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A 2022 report from The Commonwealth Fund highlighted the poor outcomes Americans experience in healthcare, especially when compared to similarly developed nations. Adults in the U.S. experience higher mortality rates overall, often as a result of chronic diseases. The healthcare system has long operated on fee-for-service payments, which prioritize the volume of care patients get over the quality of care and eventual outcomes. When there is little or no incentive to improve outcomes, it creates a perverse system that reinforces the wrong behaviors.
Fortunately, the healthcare system is moving toward a value-based care (VBC) future that shifts our focus toward care quality and patient outcomes while also doing what we can to control costs. This approach also prioritizes overall health management, particularly for costly chronic diseases, and promotes early interventions that reduce acute events.
VBC aligns healthcare providers' incentives with the well-being of their patients, fostering a stronger focus on preventive measures, personalized treatment plans, and continuous monitoring. It emphasizes value over volume and encourages medical professionals to collaborate across specialties, reduce redundant procedures, and minimize medical errors. Ultimately, VBC empowers individuals to actively participate in their health journey while promoting a more efficient and effective healthcare system.
For payers, providers, and self-funded employers who will benefit most from this shift, successfully implementing VBC requires sophisticated technology. Software must identify and mitigate risks, surface critical data trends before they hit clinical and financial bottom lines and prescribe specific actions healthcare stakeholders can take to improve care based on the insights available.
Leveraging technology to create lasting value State-of-the-art technologies such as artificial intelligence (AI), machine learning (ML), and analytics serve as a primary data source for VBC organizations. They have the power to transform how healthcare professionals approach patient treatment to push quality to the forefront. For healthcare delivery organizations (HDOs) participating in alternative payment and care delivery models, the key is finding the right technology and leveraging it appropriately to achieve quality, cost, and patient satisfaction goals inherent in VBC.
