Future Trends to Watch for Value-Based Care

Increased Adoption By Health Care Providers

Much of the support for value-based transformation has been led by Centers for Medicare and Medicaid Services (CMS) and the Center for Medicare and Medicaid Innovation. In fact, CMS has set a target for all Medicare fee-for-service beneficiaries to be in a relationship with accountability for quality and total cost of care by 2030. ⁴ Although high-quality high-value outcomes benefit patients primarily, provider organizations and payers will experience the benefits as well. VBC participants have the opportunity to receive shared savings from payers as well as to receive a financial bonus for quality performance in the setting of improved cost of care. Medicare will continue to entice providers to participate through expansion of the accountable care organization (ACO) model through ACO Realizing Equity, Access, and Community Health and additional benefits to existing Medicare VBC Programs.

As hospitals and medical practices experience financial pressures, alternative payment programs are one of the few areas that offer steady increases in reimbursement to support provider enrollment. In support of the CMS mission, for 2023, Congress has extended the advanced alternative payment model incentive payment for qualifying providers who participate in 2-sided risk arrangements. ⁵

Use of Advanced Analytics and Technology

Big data is emerging as the new currency of the health care delivery world. With advances in analytics and computing technology, including artificial intelligence (AI) and machine learning, the course of VBC will rapidly evolve in the coming years.

For instance, in the setting of new payment models emerging from CMS and commercial payers, health care delivery networks will be increasingly responsible for performance on population metrics such as mammogram rates or rates of diabetes control. Intensive analytics and the use of patient registries facilitate understanding of needed resources to achieve successful quality performance. Intensive analytics will also help providers understand who among their attributed patients is suffering with chronic illness and needs additional services such as ambulatory visits, home-based services, or ancillary supportive care.

Also, now more than ever, the practice of medicine must be guided by solid evidence in the literature. Internationally, the number of scientific publications has risen year-over-year surpassing 2.9 million articles in 2020 alone. ⁶ With the opportunity to improve outcomes through evidence-based practice, providers will be compelled to use AI resources to enhance their care delivery. Informaticists will be called upon in larger force to implement point-of-care solutions to integrate evidentiary practices to support the best possible care delivery.

Social Drivers of Health and Health Equity

Managing a population often means to manage those with the highest needs to impact their clinical course. Often within a population, those with the highest levels of need are those who have been marginalized by a complex and expensive health system. These individuals are often left to use the emergency department for primary care with minimal focus on prevention or chronic disease management. ⁷

To truly improve patient outcomes and value for a population, VBC providers must address the social drivers of health, such as access to healthy food, safe housing, and transportation. In the coming years, we will continue to see the progression of focus on social drivers of health and health equity as essential components of comprehensive care delivery as well as foundational measures in evolving CMS and commercial programs.

Personalized Medicine, Patient-Centered Care, and Outcomes

Patient-centered care, which focuses on the needs and preferences of individual patients, is a fundamental component of VBC. In the coming years, the market will continue to experience disruptors where the patient experience will continue to evolve. Patients will further anticipate user-friendly care that is convenient and available on-demand without lengthy waiting periods. Patients value the care of their physicians and want lower out-of-pocket costs and less time away from daily activities. ⁸

Synchronous and asynchronous telehealth offerings will continue to expand and concentrate on specific needs such as gender-based care, acute illness, and chronic condition management. Remote monitoring will similarly emerge as a dominant player to include discreet or continuous measurements, including technological wearables. A systematic VBC approach will support aligning platforms through data sharing and interoperability.

As the cost of genetic testing continues to drop, personalized medicine and genetics will play a larger role in managing populations proactively through risk evaluation and mitigation strategies. Genetic medicine will also help to steer drug therapies toward the right patient and avoid delays in treatment due to ineffective therapeutics.

The solvency of the highly complex payment system for health care in the United States will continue to hinge upon delivering care with incentives aligned toward improving the health of our populations. The health care delivery systems across the country that will be most successful will focus on the application of evolving technology as described for the purpose of delivering superior patient-centric equitable outcomes.