Jamie Huggins

In value-based care, shared goals between health plans and providers are only possible when both parties are working from the same playbook. But in reality, providers are often left to guess at the full picture. Many don’t have access to their patient’s complete medical history, especially those not using large EHR systems. That lack of visibility can mean missed care gaps, delayed diagnoses, and extra administrative burden for both the provider and the health plan. 

For more than 15 years, value-based care (VBC) has transformed healthcare by shifting the focus from volume to outcomes. Initially, this shift focused almost exclusively on primary care, recognizing its role as the front door to the healthcare system. But as models mature, it’s clear that meaningful progress toward high-quality, cost-effective care requires deeper integration of specialty care.  

The rise of healthcare spending in the United States is a concern that affects everyone, from health plans and providers to members receiving care. The healthcare industry is moving away from the fee-for-service (FFS) model to value-based care, and a significant reason behind the shift is due to medical costs reaching new heights.

As the healthcare industry shifts towards value-based care, health plans face the critical challenge of effectively sharing data with providers.

Healthcare risk adjustment plays an essential role in the health plan-provider relationship. At the center of this relationship is patient data, collected at the hospital and provider practice level and shared with health plans.

Healthcare has embarked on a new era of value-based care success. Achieving value-based care success is dependent on building a strong partnership between health plans and their providers.