Keep Value-Based Care Momentum Going in 2025

2024 was a banner year for value-based care (VBC), with the Centers for Medicare & Medicaid Services (CMS) announcing a record-breaking $2.1 billion in savings from the Medicare Shared Savings Program (MSSP)—the largest in its history. This achievement highlights the rapid growth and success of MSSP, which now encompasses 480 shared savings accountable care organizations (ACOs) and more than 600,000 clinicians serving 11 million Medicare enrollees.

Alongside significant cost reductions, quality scores also have improved, reflecting the positive impact of VBC initiatives on both cost and patient care.

However, with a new administration and possible cost cuts, can the nation sustain this progress? While it is anybody’s guess what will happen, there are a few positive trends that we believe can keep the momentum going.

Population Health’s Time is Now

Population health focuses on three interrelated aims to help healthcare become more effective and efficient:

• Improved care for individual patients
• Better health of populations at large
• Reduced per capita costs

Since these aims are consistent with VBC, emphasis on population health will continue in 2025, with healthcare organizations persisting in their efforts to increase patient access and preventive measures to mitigate costly medical emergencies.

Collecting social determinants of health (SDOH) data will continue to be crucial in this effort. But just as important is finding solutions for underserved populations. A Deloitte survey found that 88% of hospitals currently screen patients for social needs; however, only 33% of hospitals have a well-defined process for connecting patients with social resources.

To close this and other quality gaps, expect to see increasing reliance on qualified registries, moving away from manual data collection and chart reviews to streamlined data exchange (including supplemental data) between electronic medical record (EMR) systems and tech platforms. This initiative promises more data accuracy and less time spent on manual processes, helping to reduce human error and boost efficiency.

AI and Practice Transformation

Many practices have already adopted generative artificial intelligence (AI) to streamline operations, but AI will continue to evolve beyond rote functions like transcribing encounter notes or generating reminder texts for patients.

For example, large language models can analyze high volumes of real-time data, including vital signs, medical history, and even wearable device data, to detect subtle changes. Healthcare providers then receive alerts to potential complications, with AI algorithms suggesting tailored, early intervention treatment strategies to improve patient outcomes.

Research suggests this could quite literally mean the difference between life and death. In this study, AI-based early warning systems led to fewer nonpalliative deaths (1.6% versus 2.1%) among patients who were monitored with AI compared to those who weren’t.

Regular communications were credited with helping to reduce deaths, engaging clinicians with real-time alerts, and ensuring twice-daily emails to nursing teams and daily emails to palliative care teams. High-risk patients received increased monitoring by nurses, enhanced communication between nurses and physicians, and prompted physicians to reassess patients.

While compelling, resistance to AI continues to be a barrier, especially among physicians. According to the American Medical Association (AMA), many physicians lack sufficient knowledge about the capabilities and limitations of the technology, potentially leading to hesitation on adopting AI-powered technologies.

To help increase adoption, AI can be utilized to educate providers on suggested care strategies, providing interactive training modules that simulate real-world clinical scenarios. AI can also offer personalized feedback based on individual provider practice patterns and more.

These applications essentially allow doctors to learn how to effectively integrate AI insights into their decision-making process while understanding the rationale behind them.

Quality Will Continue to Be King

One thing is certain—in 2025, quality improvement will reign supreme, particularly as many new contracts include quality incentives for gap closure and star ratings. Identifying and acting on social determinants of health will be essential, helping providers manage patient care and mitigate health risks associated with economic or social barriers.

According to the American Hospital Association, US hospitals continue to show improvements on key safety measures, surpassing pre-pandemic levels. Despite patients being sicker, 20% were more likely to survive today compared to the fourth quarter of 2019. Notably, hospital’s central line-associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI) were lower in the first quarter of 2024 than those recorded in the fourth quarter of 2019.

AHA also reported ongoing improvements leading to a 60%-to-80% increase in breast, colon, and cervical cancer screenings in the first quarter of 2024 compared to fourth quarter of 2019.

But quality is so much more than gap closures and star ratings. It includes patient outcomes, their experience and satisfaction. It also relies heavily on easy access to care to ensure not only individuals, but entire communities stay healthy. Both payers and providers must keep these factors in the forefront to achieve success.

As value-based care continues to grow and evolve, more and more independent medical practices will begin to face significant challenges if they continue to rely on a traditional fee-for-service model. For many, it will eventually become unsustainable.

Innovista Health is 100% committed to value-based care. Whether we’re managing physician-owned IPAs and ACOs, engaging in joint ventures or mergers, or running our Innovista Medical Centers in Dallas and Houston, we are always striving for quality and performance improvement and better patient care. To learn more about how Innovista Health can help with the transition to value-based care, contact us.