“Is value based care a mirage?”
That question is getting louder across boardrooms and clinical leadership meetings.
Here’s why Despite over a decade of policy push, 70% of U.S. healthcare payments are still volume-based, not value-driven (Health Affairs, 2024). In theory, value-based care (VBC) rewards outcomes over services.
In practice? It often means chasing metrics, uneven incentives, and administrative gridlock.
So let’s get into it: is value based care a mirage or are we just approaching it the wrong way?
Is value based care a mirage?
For policymakers, VBC is the north star. For health plans and providers navigating fractured systems, it often feels like a high-stakes illusion.
Here’s why it feels like a mirage:
- Too many metrics, too little coordination
- Delayed incentives that don’t align with real-time care
- Retrospective chart reviews that disrupt workflows
How is value based care a mirage?
The value-based care dream starts to blur because of five major barriers:
Fragmented Data Systems
VBC relies on accurate, timely data across providers, payers, and vendors. But when EMRs don’t talk and claims lag by months, it’s a nightmare.
Incentive Mismatch
Providers carry the burden of change, but the benefit often shows up in payer P&Ls.
Metric Overload
When everything is measured, nothing feels meaningful. VBC programs often require tracking 80+ quality indicators.
Manual Chart Chasing
Teams spend months reconciling past visits to close gaps. That’s not scalable.
Delayed ROI
Organizations invest today for gains 12-24 months later. CFOs find this hard to justify.
“What makes VBC feel like a mirage is not its intent, but its execution.”
Value based care in Healthcare
In healthcare, the term “value” is interpreted in 100 different ways:
- For payers: Lower MLR, better Stars ratings
- For providers: Better patient outcomes, more aligned incentives
- For patients: Coordinated care, fewer surprise bills
Yet, because these stakeholders often work in silos, the system rarely delivers on all fronts at once. That’s why “is value based care a mirage” isn’t just rhetorical it reflects real operational dissonance.
The closer you get to the ground, the harder it is to see “value” in value-based care.
Role of AI in value based care
AI isn’t a silver bullet, but it’s getting close.
Here’s how it can help:
- Real-time chart reviews: No more end-of-year chaos.
- Predictive care gap detection: Proactive, not reactive.
- Stars optimization: AI can flag which charts matter most for ratings.
How Bulwark helps with value based care
RAQ+ is purpose-built for value-based care.
Unlike legacy systems that look backwards, RAQ+ works in real time to:
- Identify and close HEDIS care gaps proactively
- Monitor Stars metrics as they happen
- Align documentation with CMS & NCQA guidelines
- Improve RAF score accuracy
- Help health plans manage Medical Loss Ratio targets
RAQ+ doesn’t wait for year-end audits. It gets ahead of them.
FAQs:
What makes value based care hard to implement?
Lack of interoperability, delayed claims data, and misaligned incentives.
Can AI make value based care more effective?
Yes. AI enables real-time chart reviews, care gap alerts, and predictive quality management.
What role does RAQ+ play in value based care?
RAQ+ streamlines chart reviews, care gap closure, and quality score tracking to support Stars and RAF optimization.
Are fee-for-service models still dominant?
As of 2023, about 70% of payments are still FFS (Health Affairs).
How can health plans start seeing ROI from VBC?
By shifting from retrospective reviews to real-time interventions using platforms like RAQ+.
Conclusion:
Value-based care isn’t a mirage. But our current execution makes it feel like one.
With tools like RAQ+, health plans don’t need to gamble on Q4 anymore.
They can close care gaps when it counts, improve stars ratings early and get ahead of RAF reporting issues.
Want to make value-based care real?
Book a demo with Bulwark, and let’s turn the mirage into measurable progress.
