Five Emerging Trends in Value-Based Care

Nov 16, 2023 | Uncategorized

The practice of value-based care has gained significant momentum, driven in part by the COVID-19 pandemic, which highlighted the limitations of fee-for-service reimbursement. Healthcare providers now face increasing pressure to stay up-to-date with emerging trends in the field. In this article, we’ll explore five key trends in value-based care.


1) Embracing Value-Based Care:

A heavy reliance on fee-for-service reimbursement can leave healthcare providers vulnerable to volatility and changes in demand. Those who had invested in value-based care were better equipped to weather the storm, as they had a consistent source of revenue even during periods of low utilization. The rapid changes in healthcare delivery driven by the pandemic underscore the importance of embracing value-based care. Providers have the opportunity to realize a rapid return on their investment in value-based care, thanks to stable revenue streams and new regulatory flexibilities. Innovative care delivery models further enhance this potential.


2) Continued Innovation and Disruption:

Value-based care has long been a hotbed for innovation, and we are seeing a surge in innovation and disruption in both payment and care delivery models. The Centers for Medicare and Medicaid Services (CMS) had prioritized value-based care during the Trump administration, and the Biden administration’s health care goals are likely to further emphasize cost savings, driving a greater push towards value-based care. Commercial payers are also seeking innovative payment and care models, especially in light of the disparities highlighted by the pandemic.


3) Leveraging COVID-19 Infrastructure:

The COVID-19 pandemic prompted transformative changes to the healthcare system. These changes created ongoing opportunities to manage patient care and provide high-quality services in lower-cost settings. Telemedicine and digital health modalities, initially introduced as temporary measures, have become permanent fixtures in healthcare. Providers who adopted digital health solutions during the pandemic can now capitalize on this investment to manage patient care efficiently and see returns on services that were traditionally unreimbursable under fee-for-service arrangements. Programs like the Hospital Without Walls and Acute Hospital Care at Home have also opened doors for lower-cost services that benefit providers.


4) New Opportunities for Provider Alignment:

Recent changes in federal law have aimed to lower barriers to value-based care. CMS and the Office of Inspector General (OIG) have introduced new flexibilities under the Stark law and Anti-kickback Statute for value-based arrangements, allowing providers to enter into arrangements that were previously restricted. These exceptions and safe harbors provide new opportunities for providers. Careful crafting is required to take advantage of these allowances. They enable providers to align and incentivize activities that promote value-based goals. Additionally, information blocking rules ensure patients and providers can access health information, further reducing structural barriers to value-based care.


5) Focus on Social Determinants of Health:

In the value-based care space, especially in Medicaid programs, there is a growing emphasis on addressing social determinants of health. Providers and payers recognize the significant role that non-medical factors play in patient health. Providers and payers can achieve notable improvements in patient health and outcomes by addressing issues such as transportation, food, housing, and language services. Simultaneously, they can maintain relatively low medical costs. The focus on social determinants of health is an emerging trend in value-based care. This trend is expected to grow as stakeholders seek creative ways to manage patient arrangements.


Healthcare providers and payers are emerging from the upheaval caused by the pandemic and the revolutionary changes in healthcare. A renewed interest in value-based care is expected! Opportunities abound to fully investing in patients.


Post adapted from original article published on 
Photo from NCI