Skip to main content

The Role of Technology in Advancing Value-Based Care

The Evolution of Value-Based Care

While the term “value-based care” has gained popularity, its widespread adoption has been slower than anticipated. It essentially represents different contracting models beyond traditional fee-for-service reimbursement that aim to reduce costs and improve health outcomes.

The main challenge in expanding value-based care is getting both payers and providers comfortable with the uncertainty of reimbursements under these arrangements. Providers often struggle to shift from their fee-for-service mindset and adapt their business operations to take on financial risk. Payers are often unsure about how to best build and manage their care networks to achieve their value-based care goals while also meeting the needs of the populations they serve.

Building a partnership between payers and providers, based on transparency and information symmetry, is crucial for successful value-based care implementation.

The Role of Technology in Value-Based Care

Complex workflows, analytics for identifying gaps in care, and member risk stratification can be facilitated by modern care management systems. Digital tools and mobile infrastructure can empower members to be more engaged in their care, especially when they are outside of their traditional healthcare setting.

Technology can also help health plans tap into the vast amount of data they possess to evaluate performance across various measures, such as HEDIS and STAR ratings. It can also be used in predictive modeling for gaps-in-care analysis, which can help identify members at risk before they experience an adverse event.

Many health plans face challenges in consolidating data, analyzing it effectively, and presenting actionable insights from it. Modern technology platforms are needed to support value-based contracting, enabling accurate comparisons between providers on different payment models, and fostering transparency in the provider-payer relationship.

HealthEdge’s Contribution to Value-Based Care Success

HealthEdge offers modern technology solutions that support payers’ efforts to manage value-based care arrangements. HealthEdge products, such as HealthRules® Payer, GuidingCare®, and Source streamline claims management, adjudicate capitation arrangements, facilitate care management workflows, and improve payment integrity. The company’s Wellframe® product enables digital care management, enhancing patient engagement and improving health outcomes. HealthEdge’s technologies aim to simplify healthcare processes, deliver real-time information, and improve overall member experiences.

At HealthEdge, we believe value-based care holds the potential to transform healthcare delivery and reduce costs. That’s why we are focused on helping the healthcare industry make progress against their value-based care goals by leveraging technology to provide real-time cost and benefit information to members and providers, resulting in greater transparency and better healthcare experiences.

To learn more about how HealthEdge solutions can help your better manage risk, streamline operations, and enhance member experiences, and pursue value-based care arrangements, visit