Healthcare is undergoing a major shift. Rising costs, a growing number of chronic disease cases and an aging population have revealed the limitations of the traditional fee-for-service (FFS) model. Under FFS, providers are paid based on the volume of services rendered—regardless of the outcomes. This has led to inefficiencies, fragmented care and increasing financial pressure on both patients and payers.

In contrast, value-based care (VBC) models prioritize outcomes over output. Instead of rewarding the number of procedures, VBC encourages preventive care, improved patient outcomes and coordinated treatment plans. This approach is gaining traction across the healthcare ecosystem as a more sustainable and effective way to deliver care.

The payer’s crucial role in advancing value-based care

Payers are uniquely positioned to lead the charge toward value-based care. Their role goes far beyond reimbursement; they can shape incentives, guide provider behavior and ensure the right data and tools are in place to support this transformation.

Here’s how payers can drive impact:

• Educating providers: Not all providers are equally familiar with VBC models. Payers can help bridge the knowledge gap by offering training and resources that support care coordination, outcome tracking and performance-based incentives.
• Sharing data strategically: Payers have access to comprehensive claims data and patient population insights. When shared responsibly with providers, this data can help identify care gaps, improve patient engagement and drive better health outcomes.
• Implementing technology: The shift to VBC demands robust data aggregation, analytics and reporting tools. These technologies empower providers to make informed decisions and help payers evaluate the effectiveness of their programs.

Why technology is essential

The backbone of value-based care is data—and the ability to act on it. Without integrated digital systems, it's difficult for providers to track performance metrics, manage high-risk populations, or streamline workflows.

Key technologies include:

• Data aggregation solutions: These platforms unify clinical and claims data from disparate sources, offering a 360-degree view of each patient’s health journey.
• Predictive analytics: Advanced algorithms can identify patients at risk of complications, enabling earlier interventions and reducing avoidable costs.
• Embedded workflows: Tools that integrate directly into provider systems reduce the administrative burden and support real-time clinical decision-making.

How Veradigm supports payers in value-based care

Veradigm offers a comprehensive set of solutions designed specifically to help payers succeed in value-based care environments. Their tools focus on improving interoperability, reducing friction and generating actionable insights.

Highlighted Veradigm products include:

• Veradigm Network: A secure, interoperable platform that connects stakeholders across the healthcare ecosystem. It enables more efficient data sharing and supports better clinical and financial decision-making.
• Veradigm eChart Courier™: Simplifies and automates the retrieval of medical charts for quality measurement, risk adjustment and audit purposes—saving time and reducing errors.
• Veradigm Payer Analytics: Provides real-time performance monitoring, KPI tracking and predictive insights that help payers adjust VBC strategies proactively.
• Veradigm Payer Insights: Integrates payer data directly into providers’ electronic health records (EHRs), issuing real-time alerts about care gaps and supporting better outcomes during patient visits.

Conclusion

For payers, value-based care is more than a reimbursement model—it’s a pathway to a more effective, sustainable and patient-centered healthcare system. But success requires the right combination of data, collaboration and technology.

Veradigm’s solutions are purpose-built to meet those needs, offering payers the tools to not only track and improve performance but also empower providers and patients alike.