The Shift Towards Value-Based Care in Tech

Most healthcare providers say they care about outcomes. But their systems are still designed around visits, not the patient journey. Real value-based care starts with this mindset shift: You’re not treating a visit. You’re managing a care journey. So, what should providers actually do to make that real? 1. Map the care journey Start with key cohorts—e.g., diabetic seniors or post-acute care patients. Ask: What does a good 6-month journey look like? Then map it backwards. What data, interventions, and check-ins are needed? 2. Expand the data lens Clinical data is just 50% of the story. You need SDOH (housing, food, income), behavior (adherence, mood), and context (caregivers, home support). 3. Stratify risk proactively Don’t wait for ER visits. Build simple models that combine clinical risk + social risk. Then segment patients into high, rising, and stable risk groups. Use AI to predict who's likely to fall through the cracks. 4. Close the loop with AI AI should surface next-best-actions: Who needs a nudge today? What’s changing in their baseline? What care gaps are widening? Think of AI not as a tool, but as a teammate, watching the journey 24/7. 5. Build a longitudinal feedback loop If you don’t measure outcomes across time, you’re blind. Use dashboards that show: Outcome trends per patient cohort, ROI on interventions, Impact of addressing SDOH. At Inferenz, our mission is clear: Help providers operationalize the care journey using data, AI, and human-centered design. Because value-based care isn’t a future model: it’s an execution challenge. And we’re building the rails to make it real.

One of the most exciting shifts happening in healthcare today isn't just about detecting chronic diseases earlier—it's about empowering primary care physicians to act on that information in real time. This week, our Counterpart Health subsidiary released new results showing that having a relationship with a primary care physician that uses Counterpart Assistant is associated with meaningfully better outcomes for patients with congestive heart failure (CHF) enrolled in Clover Health’s Medicare Advantage plans:  - 18% lower all-cause hospitalizations - 25% lower 30-day readmissions At first glance, these stats are impressive on their own. CHF is a leading cause of hospitalizations among seniors, and interventions that move the needle even slightly are rare. But the bigger story here is what these results say about the future of healthcare: technology that works with physicians—rather than burdening them—is how we bend both the quality and cost curves. Most healthcare technology has asked physicians to do more: more documentation, more box-checking, more clicks. We've taken a different approach. Counterpart Assistant delivers clinical-grade insights directly into the physician workflow—designed not to add burden, but to augment their decision-making and make high-quality care easier to deliver, not harder. This impact compounds over time. It isn’t just about identifying one disease a little earlier or generating one better HEDIS score. It’s about embedding intelligence into the day-to-day fabric of primary care, so that complex, high-burden diseases like heart failure can be managed more proactively, more thoughtfully, and ultimately with fewer hospitalizations and better patient lives. We believe this kind of physician enablement isn’t optional if value-based care is going to succeed at scale—it’s foundational. And as our latest report continues to show, when you align technology, physician experience, and patient outcomes the right way, you don’t have to choose between better quality and lower cost. You can achieve both. #CloverHealth #HealthcareInnovation #ClinicalAI #PrimaryCare #MedicareAdvantage #ValueBasedCare #CongestiveHeartFailure

My Friday post about the continued struggles of VBC struck a chord and led to an excellent discussion. Pointing out flaws and shortcoming is one thing (and something we have plenty of in healthcare). Ultimately, offering solutions is more helpful. CMMI's struggles suggest that value doesn’t reliably emerge from controlling disparate portions of the care continuum. Taken independently, reducing postop acute care, avoiding unnecessary procedures and imaging, and nudging primary care toward risk leads to some gains -- but the whole isn't always greater than the sum of its parts. These mechanisms help, but they're rarely transformative. Rather than stacking up small wins, we should be figuring out how to re-wire the system. That's how to get the big wins that have been elusive. True value emerges when the full care pathway is redesigned from end to end. Not to avoid or gatekeep care, but to incentivize detection and early intervention while making sure patients get the right care, earlier, more precisely, and with better feedback loops. Start with prevention, risk profiling, and early diagnosis. Build pathways that encourage—not delay—high-quality, efficient specialist care. Create small, focused centers of excellence that do a few things incredibly well. Then loop the patient back to a central hub for long-term maintenance and proactive management. Create a coordinated cycle of care that prevents problems, identifies them early when they arise, and delivers the highest quality, most specialized care when needed. Closing the loop means cycling patients back to the central healthcare hub of maintenance and prevention. This isn’t vertical integration for financial ends or carrot-and-stick value mechanisms. It’s ownership of the entire care process for better outcomes. Call it VBC or something else. Either way, its broad systemic redesign, not another confusing, cumbersome, bloated program. #healthcare #valuebasedcare #innovation