How Healthcare can Innovate for Value-Based Care

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

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.

Specialty care remains the biggest driver of healthcare costs, yet it lags behind in value-based care (VBC). To unlock its full potential, we must integrate innovative models that enhance efficiency, align incentives, and improve patient outcomes. Building on Manmeet Kaur’s insights, here are three critical components that should be at the forefront of specialty VBC: 1️⃣ E-Consults & Value-Based Referrals – Too many specialty referrals are unnecessary, leading to inefficiencies and delays. E-consults allow primary care physicians to consult specialists remotely, resolving many cases without an in-person visit—reducing avoidable referrals by up to 70%. Platforms like PicassoMD take this further by optimizing referrals so that when in-person visits are necessary, they go to high-value specialists. This improves access, enhances outcomes, and lowers overall costs. 2️⃣ Maryland’s EQIP – A Blueprint for Specialty Gain-Sharing – The Episode Quality Improvement Program (EQIP) in Maryland is proving that specialists can thrive in value-based models. By structuring episode-based gain-sharing, EQIP has shown how specialists can earn up to 80% of the savings they generate while improving care. This model provides a scalable framework for other states looking to engage specialists in value-based arrangements that align financial incentives with better care delivery. 3️⃣ The Role of Actuarial Expertise in VBC – Developing sustainable specialty VBC models requires precise financial design. Firms like Accorded specialize in actuarial analytics, helping organizations structure risk-adjusted contracts, measure impact, and fairly adjudicate savings. Without these capabilities, many specialty VBC models struggle to scale or achieve meaningful financial alignment. 🔹 The Path Forward – Specialty VBC doesn’t succeed in silos. It requires primary care and specialists working together, technology to optimize referrals, proven financial frameworks like EQIP, and actuarial expertise to make these models sustainable. What specialty VBC innovations have you seen gaining traction? Let’s continue the conversation and accelerate the future of specialty value-based care. #ValueBasedCare #SpecialtyCare #HealthcareTransformation #HealthTech #digitalhealth #innovation Quintuple Aim

In my years in healthcare, I've observed a troubling disconnect: while home health services consistently provide quality care at lower costs, they remain severely underutilized in our healthcare system. The evidence is clear - patients heal better in the comfort of their own homes, experience fewer complications, and report higher satisfaction with their care. Home-based services prevent costly hospital readmissions and reduce the need for facility-based care. Yet our current reimbursement structures actively discourage utilization. Fee-for-service models, where reimbursement is often below the cost of providing care, offers inadequate compensation for home-based solutions. Yet healthcare providers have little financial incentive to experiment with new care models absent a payment mechanism. This misalignment between patient outcomes and financial incentives creates a system where the most cost-effective options may be the least financially viable for providers. If we're serious about bending the healthcare cost curve while improving patient experience, we must test new reimbursement models that incentivize scalable and cost-effective home-based services, including key elements such as: ◾ An efficient and focused home-based assessment that identifies key real-world challenges in the patient's living environment ◾ Care coordination services to navigate follow-up appointments and medication regimens ◾ Dedicated caregiver support, including personal care assistance and respite options ◾ Care gap identification with connections to community health resources and solutions Value-based payment systems that reward providers for delivering efficient, effective care in the home are long overdue. #HealthcareReform #HomeHealth #ValueBasedCare #HealthcarePolicy

The future of value-based care depends on how we manage data—period. I just published a deep-dive on what it really takes to build a Multi-Source Data Warehouse for Risk-Bearing Provider Groups and Payors—the kind that doesn't break when complexity scales. This isn't theory. It's built on real-world lessons from the trenches at Incuvio Health Inc —where we’ve turned data chaos into clarity for organizations managing tens of thousands of Medicare Advantage lives. Eligibility, capitation, claims, labs, HIEs, pharmacy, supplemental data—if you're not stitching it all together in real-time, you're leaving money, compliance, and patient outcomes on the table. I break down the 7 core building blocks, the architectural blueprint, and the common mistakes to avoid. 👊 This is for operators who are serious about transforming their data strategy from a bottleneck into a competitive advantage. 👉 Read it. Share it. Build better. #HealthcareData #RiskAdjustment #ValueBasedCare #DataWarehouse #PopulationHealth #IncuvioHealth #HealthcareInnovation

A new publication in NEJM Catalyst highlights a promising model: Urgent Care at Home (UCAH). University of California, Davis (Thank you Vimal Mishra, MD for sharing and congratulations on this milestone!!), in partnership with DispatchHealth, provided their latest data showing that this approach can significantly reduce avoidable ED visits while maintaining high patient satisfaction and proper detection of actual emergent cases that need an ED visit, showcasing early proof of concept for this evolving model. With its recent merger with Medically Home, #DispatchHealth is now positioned to expand operations and strengthen the bridge between urgent care and longitudinal home-based acute care, aka Hospital at Home. This model leverages the synergy of remote patient monitoring (#RPM), robust care coordination, and evidence-based clinical care—key pillars for scalability, quality, and safety. What’s exciting is how this approach complements the broader Hospital at Home movement. Together, they form a high-value ecosystem that can lower costs, improve outcomes, and offer care where it matters most, at home. However, regulatory clarity and support are critical for sustainable growth. The future of home-based care hinges on continued Centers for Medicare & Medicaid Services support, waiver extensions, and broader payment reforms, and I hope that policy keeps pace with innovation. #ValueBasedCare #HospitalAtHome #UrgentCareAtHome #DispatchHealth #NEJMCatalyst #HealthTech #RemoteMonitoring #CareCoordination #PopulationHealth #HealthcareInnovation Link: https://lnkd.in/grcxUbkr