Robust Investments and Disruptive Technological Innovation Transforming Care Delivery
According to the Centers for Medicare and Medicaid Services (CMS), value-based care (VBC) programs reward healthcare providers with incentive payments for the quality of care they provide Medicare patients.
These programs are part of its larger CMS quality strategy to reform healthcare delivery and payment. Value-based programs support 3 aims: better care for individuals, better health for populations, and lower cost of care. This study analyzes digital health solutions for payers and providers (including physician practices and hospitals) that enable VBC programs. It excludes solutions targeting life sciences, pharmaceutical companies, and the public sector. Evaluations are exclusive to the United States, with concept considerations based on the CMS.
The study addresses the current status of value-based programs and payment incentives by CMS, such as ACO REACH, MSSP, MCP, and AHEAD models, alongside regulatory updates and growth opportunities for the next five years. It additionally assesses the role of digital health providers and payers in digital quality measurements and performance gaps, showcasing best practices from established US companies and start-ups enabling VBC through digital health solutions.
Table of Contents
1 Strategic Imperatives
- Why is it Increasingly Difficult to Grow?
- The Strategic Imperative 8™
- The Impact of the Top 3 Strategic Imperatives on the US Value-based Care (VBC) Industry
- Growth Opportunities Fuel the Growth Pipeline Engine™
2 Growth Opportunity Analysis
- Scope of Analysis
- Market Segmentation
- Payment Incentives - CMS VBC Models
- Payment Incentives - Accountable Care Models
- Payment Incentives - Accountable Care Models: Medicare Shared Savings Program (MSSP)
- Payment Incentives - Accountable Care Models: ACO Realizing Equity, Access, and Community Health (ACO REACH) Model
- Payment Incentives - Accountable Care Models
- Payment Incentives - Disease-specific and Episode-based Models
- Payment Incentives - Medicare Access and CHIP Reauthorization Act of 2015 (MACRA): Merit-based Incentive Payment System (MIPS)
- Payment Incentives - MACRA: Alternative Payment Models (APMs)
- VBC Programs and Legislation
- How to Measure Quality?
- How to Measure Quality? - The 6 Healthcare Quality Priorities
- How to Measure Quality? - Digital Health’s Role
- How to Measure Quality? - Payer’s Role
- Addressing Gaps in Performance Measurement
- Established US Companies and Start-ups Enabling VBC through Digital Health Solutions
- Growth Drivers
- Growth Restraints
3 Growth Opportunity Universe
- Growth Opportunity 1: Standardization of Digital Quality Measures (dQMs)
- Growth Opportunity 2: Behavioral Health and Telehealth Investment
- Growth Opportunity 3: Small and Medium Practices Demand
- Growth Opportunity 4: Generative AI for Physician Burnout
- List of Exhibits
- Legal Disclaimer
