As I’m sure you know, times are tough. Wages have largely remained the same while prices have risen across the board – and healthcare is no exception. So while people are trying to solve how to make their rent, afford their groceries, pay off their loans/debts, etc., trying to find the budget for healthcare costs, especially unplanned healthcare costs, can be extremely difficult, if not impossible. While you obviously want your organization to be compensated for the services you provided, understanding the financial situations of your patients and trying to meet them where they are is crucial.
We reached out to our beautiful Healthcare IT Today Community to ask — what innovations in healthcare IT are supporting the transitions from fee-for-service to value-based payment models for payers and providers? The following are their answers.
Ram Krishnan, CEO at Valant
More clinicians and third-party payers are beginning to recognize the advantages of a value-based care model in the behavioral health industry. Under a value-based care model, clinicians are reimbursed based on the quality of care given. This is usually measured by patient outcomes, using mental health assessment tools. Value-based care emphasizes long-term patient outcomes by aligning incentives with the quality and effectiveness of care, rather than the quantity of services provided. Unlike fee-for-service models that reward volume—such as the number of visits or procedures—value-based care prioritizes continued health improvements and prevention.
With the consistent use of clinical data, better care can be provided at both the provider and practice levels. Clinical registry data can be extracted directly from the EHR system, allowing clinicians to focus on patient treatment, providing insight into the most severe symptoms. This data also delivers greater clinical effectiveness by providing opportunities to consistently assess patient progress and adjust treatment strategies quickly and in a more targeted way.
Dr. Scott Schell, Chief Medical Officer at Cognizant
In supporting the transition from fee-for-service to value-based payment models for payers and providers, healthcare IT innovations play a crucial role. AI-powered transformation of data into actionable insights aids in patient care and wellness management. Automated, seamless, and timely (ideally real-time) reimbursement solutions streamline financial operations. Cloud-based, interoperable data frameworks create a unified data ecosystem that facilitates efficient data handling. Lastly, patient engagement and remote patient monitoring tools enhance the overall patient experience and improve care outcomes.
Ron Margalit, Chief Information Officer at Evergreen Nephrology
There continues to be a learning curve for providers as some healthcare specialties transition from a fee-for-service (FFS) to a value-based care (VBC) payment model. VBC requires a different way of thinking. While FFS incentivizes the quantity of services delivered, VBC prioritizes the quality of patient outcomes – with provider reimbursements reflecting the separate goals of each model. To aid in a seamless transition to VBC, healthcare technology needs to bear the brunt of the administrative burden, effortlessly guiding providers through documentation and reimbursements. Since clinicians must frequently pivot from patient to patient and attend to each of their unique needs, VBC requires a reliable, integrated healthcare system to ensure they are equipped with the right tools and data at the right time to deliver high-quality, coordinated patient care.
Sam Gopal, Senior Vice President, Product & Technology at Interwell Health
Innovations supporting the move to value-based payment models are centered on improving data integration, automating administrative tasks, delivering actionable insights at the point of care, and bridging fee-for-service and value-based care workflows. The most innovative systems are designed for usability, integrating intuitive workflows and mobile-first interfaces that “meet clinicians where they are,” resulting in higher adoption and meaningful improvements in both clinician experience and patient health.
In the paradigm shift to value-based care, providers need to adjust practice operations and financials to account for delayed, outcomes-based payments. Solutions such as population health dashboards can help ease the transition from encounter-driven systems to workflows that align behavior with quality measures and shared savings incentives.
For example, EHRs optimized for value-based care make it easy to attribute patients to value-based contracts, monitor longitudinal outcomes, identify and close care gaps, and implement preventive interventions such as post-discharge follow-ups. And when organizations combine EHRs with advanced analytics platforms, they can automatically track progress toward key metrics, course-correct in real time, and reduce time spent on regulatory reporting.
Donald Rucker, MD, Chief Strategy Officer at 1upHealth
Value-based payment models are finally getting the infrastructure to truly calculate value. Historically, value-based payment (what you get and how much you pay for it) couldn’t really handle the “what you get” part of this simple economics equation. Folks relied on quality measures – an optimistic abstraction about the care provided. Now, with more clinical data being converted into the FHIR standard, modern high-volume machine learning and AI tools can provide much richer interpretations of value, rather than the simple quality scores that have been our placeholders for measuring value in the past.
Charlie Byrge, SVP of Revenue at Tendo
The shift to value-based care requires healthcare IT to support new payment structures, care delivery models, and performance measurement frameworks. Innovations include episode-based bundled payment platforms, prospective pricing tools, and analytics systems that track quality and cost metrics in near real time. Care navigation platforms that help steer patients toward high-value, cost-effective care options are also gaining traction. Additionally, contract management and payment reconciliation tools are evolving to handle the complexity of value-based agreements. These technologies not only help operationalize value-based contracts but also foster transparency and trust between payers and providers, essential for sustainable partnerships in this new model.
Scott Clinton, Director of Product Development at Solventum
Shifting from fee-for-service to value-based care requires more than new payment models—it demands transforming how healthcare data is collected, integrated, shared, and used. Healthcare IT is the backbone enabling this shift.
At the center is data transparency between payers and providers. Without shared visibility, efforts are blocked by siloed data, misaligned incentives, and unclear expectations. IT solutions bridge these gaps by ensuring both sides understand the arrangement, track performance, and have the tools to improve outcomes.
Real-time dashboards and analytics make this actionable. With intuitive tools, payers and providers can track performance, monitor outcomes, and identify quality gaps. Tools like care gap analysis and risk stratification guide targeted interventions, while platforms that aggregate outcome data—such as potentially preventable admissions, ED visits, and readmissions—reveal trends and drive population health improvements.
Predictive modeling builds on this by identifying high-risk, high-cost patients early, allowing for proactive care that prevents unnecessary utilization and helps providers focus on preventive care and effective patient management – key components of value-based care. But those insights are only as strong as the data behind them, making interoperability and access to external encounter data essential for informed, coordinated care.
Finally, scalable cloud infrastructure is key. It enables real-time analytics, supports dynamic care planning, and processes large datasets efficiently, all critical for managing complex patient populations at lower operational costs.
Healthcare IT isn’t just a support function. It’s a strategic driver. By breaking down data silos, enabling smarter care, and surfacing insights that improve outcomes, IT innovation is the foundation of a sustainable value-based healthcare system.
Dale Sanders, Chief Product and Technology Officer at Unite Us
The innovation isn’t just in tech—it’s in architecture and alignment. Modular platforms that can ingest multi-source data, analyze performance against quality metrics, and support dynamic contracting (like episode-based or outcomes-based payment) are gaining traction. Smart contracts, interoperable care pathways, and embedded quality reporting dashboards are also bridging the gap. Ultimately, successful value-based care depends on systems that connect payment to purpose—and tech that adapts to both. In our market space, we’re seeing a recognition by insurance companies that reimbursing for community-based care, such as food services, transportation, and job placement services, makes long-term economic sense for the insurance company and their medical loss ratios. If they invest a little now, they save a lot later.
What great answers! Huge thank you to everyone who took the time out of their day to submit a quote to us! And thank you to all of you for taking the time out of your day to read this article! We could not do this without all of your support.
What innovations in healthcare IT do you think are supporting the transitions from fee-for-service to value-based payment models for payers and providers? Let us know what you think over on social media, we’d love to hear from all of you!
