The following is a guest article by Dana McCalley, VP of Value-Based Care at Navina
The value-based care (VBC) market is projected to experience market growth from $12.2 billion in 2023 to $43.4 billion by 2031. This shift reflects a broad industry push to prioritize rewarding better patient outcomes over higher service volume. Yet despite this momentum, skepticism remains. Many organizations still struggle with administrative burden, unclear incentives, and disappointing early ROI, leaving some to wonder whether VBC is truly worth it.
In many cases, the problem isn’t the VBC model itself. Rather, it’s the lack of a clear, actionable strategy, aligned stakeholders, and the right tools to support execution. Here’s what often gets misunderstood, and what it takes to turn VBC from a burdensome task to a successful, patient-first model.
Misconceptions about VBC
There are three main misconceptions I frequently encounter regarding VBC.
VBC Just Adds More Administrative Burden
It’s true that VBC introduces new reporting and measurement requirements. But the deeper issue is that many clinicians lack visibility into how their actions translate to payment, largely because attribution rules, incentive structures, and payer reporting vary widely. When providers don’t have transparency into performance and lack tools that surface this information in their workflow, VBC can feel like extra work with unclear payoff.
Healthcare Already Has Plenty of Data
There is plenty of data—but very little of it is streamlined, and most of it is siloed. Claims, clinical records, labs, notes, and HIE feeds all live in different places, requiring analytics teams to piece information together. Providers rarely receive a complete picture at the point of care. This fragmentation fuels the administrative burden and limits a provider’s ability to act holistically. While solutions are available that allow them to streamline their operations, many providers don’t realize that these options are available to them.
Implementing VBC is Easy
The third misconception is that VBC is easy to implement. As we’ve seen more venture capital flow into the space, the infrastructure, complexity, and dynamics of where a provider operates are sometimes underestimated. In addition, successful VBC-oriented primary care groups often feel pressure to change their models when they get funding, often negatively impacting patient care. VBC requires the involvement of providers and communities, acknowledging the varying landscapes across different regions.
The Missing Ingredients to Make VBC Work
Two key elements are often overlooked:
- VBC is a team sport; everyone—front desk staff, medical assistants, care coordinators, call centers, referral teams, payers, and analytics teams—has an important role to play; when these moving parts aren’t aligned, even well-designed VBC programs will falter
- The goal is to make things easier for the provider by reducing friction at the point of care; providers need data that arrives on a ‘silver platter’: clean, reconciled, and immediately actionable, rather than forcing them to dig through portals, PDFs, or spreadsheets
One unified platform can help achieve these aims by bringing in data from payers, provider groups, HIE, and more, and then synthesizing this information so it’s super easy to engage with when a provider receives it. Key elements to look for in a platform include the ability to:
- Reconcile ambient conversation data with the patient’s entire historical record to surface actionable insights (suspected diagnoses, risk drivers, gaps in care) directly at the point of care
- Gain full visibility into your organization’s value-based performance with robust reporting for key metrics
- Track usage and performance metrics by clinic, location, and individual users
- Identify areas of friction and opportunities for training
- Leverage data to drive targeted interventions to boost provider engagement and enhance network performance and patient outcomes
- Integrate with your existing business intelligence dashboards
Preparing for the Future
Value-based care isn’t a passing trend. It’s the future of our healthcare system. Healthcare practices need to gain a firm understanding of the model now to drive better patient outcomes and ensure compliance. With the right strategy, VBC can deliver on its goal of better outcomes, lower costs, and healthier patients.
