5 Foundational Capabilities Needed for Implementing a Value-Based Care Program

Healthcare providers and practices face significant challenges in the United States, where despite the highest healthcare spending globally, patient outcomes lag behind other high-income nations. Value-Based Care (VBC) aims to address this by rewarding providers for delivering measurable, cost-effective health outcomes. Embracing VBC offers opportunities to enhance patient well-being while protecting practice profits in a stagnant fee-for-service environment. CMS.gov data reveals physician and clinical service expenditures at 5.6% in 2021, with VBC spending growing at a 15% annual rate. However, barriers to entry include evolving regulations, resource constraints, revenue unpredictability, and limited healthcare data access. Practices must navigate these challenges by supporting fee-for-service while participating in VBC programs, necessitating the development of essential capabilities to thrive in this evolving payment landscape. These foundational capabilities will empower practices to excel across the value-based care spectrum as reimbursement trends shift.