价值医疗的下一阶段：为什么专科主导模式将定义医疗保健的未来

More than three-quarters of health system and hospital executives plan to expand participation in value-based care (VBC) models over the next two years, up from 57% in 2023. But despite growing momentum, value-based care has yet to fully deliver on its promise of improving patient health while reducing costs.

A key challenge is that value-based care asks providers to manage outcomes across a patient journey they often cannot fully see. This issue is especially acute for specialists managing patients with multiple comorbidities, where fragmented visibility across the care journey can directly impact outcomes.

The

rise of AI use among physicians creates new opportunities to improve patient identification and engagement. But technology alone isn’t enough. Providers also need robust care infrastructure to translate insights into timely intervention.

By Michael Blackman, MD, MBA Chief Medical Officer, Greenway Health®

The next evolution of value-based care will depend on whether specialist providers can operate with continuous visibility into patient risk, not just episodic insight during office visits.

Moving from incentives to outcomes in value-based care

For providers, the appeal of value-based care models often stems from financial incentives. The opportunity to earn performance-based rewards and share in savings by reducing the total cost of care is a motivator to move beyond fee-for-service models.

Yet, realizing shared savings requires providers to fundamentally change their behavior and scope of practice. This is true across specialties, including primary care, but particularly for specialists managing medically complex patients.

Sponsored Post

Where Will AI Deployment Benefit Payers the Most?

We are taking a look at how health insurers are using AI, defining success, and managing cybersecurity risks. Give us your opinions by completing our brief, anonymous survey.

By MedCity News

For example, consider a nephrologist managing patients with kidney disease. Historically, nephrology workflows have been focused around kidney function, with less attention on comorbidities such as diabetes, cardiovascular disease, hypertension and depression that drive total patient risk.

In a value-based care model, however, this fragmented approach often proves ineffective at minimizing avoidable costs. Instead, the nephrologist must take accountability for the full patient experience, working closely with other providers and support resources such as cardiologists, endocrinologists, social workers and nutrition specialists to improve patient outcomes.

This reflects a broader shift in the healthcare landscape toward addressing speciality care cost drivers. Patients with multiple chronic conditions account for a disproportionate share of healthcare utilization and costs, including 64% of all clinician visits and 93% of Medicare spending.

When specialists act as “quarterbacks” for medically complex patients, providers and payors alike can benefit from more cost-effective care — but success depends on strong coordination across the patient journey.

What it will take to make value-based care work beyond 2026

Value-based care requires both providers and payors to embrace a more holistic approach to patient health management.

For providers, this means supporting patients beyond their traditional scope of practice and collaborating across the care continuum. For payors, it means building deeper partnerships with providers and integrated care teams to reduce fragmentation and cost pressures.

Going forward, specialists can play a central role in advancing value-based care by improving outcomes for complex, high-cost patient populations. However, they must be empowered through several core pillars:

1.

AI intelligence to identify risk and guide provider action

. AI helps providers transition from reactive to proactive care — a critical shift in value-based models. This is especially true for specialists managing medically complex patients, where early intervention is essential to prevent avoidable hospitalizations and downstream costs.

For example, transcriptional AI can capture and synthesize physician-patient interactions in real time, summarizing key risk areas and suggesting next best actions, such as a follow-up on medication adherence.

When combined with other real-time data sources, including clinical notes, EMR information, lab results, pharmacy data and hospital admission-discharge-transfer (ADT) feeds, physicians gain a comprehensive view of emerging risks between visits.

With access to continuous patient insights, specialists can work alongside supporting care teams to proactively intervene and meet patient needs rather than respond to acute events.

2.

Care coordination to address barriers to treatment

. While AI can surface patient risks and care gaps, intentional care coordination turns insight into action.

Consider the fact that hemodialysis patients miss approximately 10% of treatments, with over half of missed treatments due to absences. In many cases, these absences are tied to factors such as lack of transportation or limited caregiver support.

An integrated patient care team can support nephrologists by helping arrange transportation and address this adherence barrier. Likewise, coordination with resources like nutritional counselors and social workers can help manage specific patient comorbidities.

As AI supports timely risk detection, specialists will increasingly rely on the expertise of these multidisciplinary care teams to deliver targeted interventions that improve both clinical outcomes and cost performance.

3.

Continuous, digital-first patient engagement

. Episodic care models are poorly suited for medically complex populations, which makes continuous patient visibility increasingly important.

Patient-facing applications can support remote monitoring by capturing data on indicators, such as weight changes, that may signal an intervention need. Similarly, bi-directional texting can help care teams connect with patients in real time, whether to confirm upcoming appointments or coordinate transportation.

Virtual engagement can also offer visibility into patients’ home environments and day-to-day challenges. During virtual visits, specialists and supporting care teams may identify barriers to care that patients don’t explicitly communicate, including mobility limitations or limited caregiver support.

By enabling consistent communication and oversight outside the clinical setting, digital tools can support specialists to drive patient adherence and improve long-term care outcomes. Just as importantly, they can strengthen the patient experience itself.

Unlocking the promise of value-based care

Value-based care offers a path to sustainably reduce healthcare costs while keeping patients healthier. But achieving that promise isn’t possible without connected, digital-first care delivery.

The future of value-based care will hinge on empowering providers, and specialists in particular, with the data and strategic partnerships to proactively manage patient health beyond traditional clinical settings.

By aligning advanced technology and integrated care delivery, value-based models can move from promise to practice — and achieve better results for even our most complex patient populations.

Photo: nevarpp, Getty Images Paul Marchetti Paul Marchetti is the President of Strive Health. As Strive’s President, Paul oversees operations, customer success and growth. Before joining Strive, Paul served as President of CarelonRx at Elevance Health, where he led the pharmacy division through substantial growth, increasing its value to over $35 billion in three years as well as acquiring key assets like BioPlus, Paragon Healthcare and Kroger Specialty Pharmacy. Earlier in his career, Paul held senior executive roles at New Century Health, Aetna and United where he drove revenue growth, managed national provider and value-based networks, scaled clinical operations and strategic M&A efforts. Paul has a BAS in Healthcare Administration and Management from Springfield College and an MBA in Healthcare Management from the University of New Haven.

This post appears through the MedCity Influencers program. Anyone can publish their perspective on business and innovation in healthcare on MedCity News through MedCity Influencers.

Click here to find out how