#value-based care

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Value-based care is a red flag that a healthcare CEO was not thinking things through.

Everyone else notices how this “value-based care” idea will lead to grotesquely perverse incentives, right? Physicians for a National Health Program at least recognized the problem.

People - Wife of Murdered UnitedHealth CEO Brian Thompson Says He Received Threats and She's 'Trying to Console' Their Children - the wife of slain CEO Brian Thompson, said her husband did not alter his travel plans in spite of the threats. By Liam Quinn Published on December 4, 2024, 12:38 PM EST. Part of the text is highlighted with a marker, the part highlighted is “did not alter his travel plans in spite of the threats”.

I’m sorry if this seems like victim blaming, but I do think this demonstrates that people who become CEOs of giant healthcare corporations should definitely not be assumed to be particularly clever or insightful, I also think they shouldn’t be trusted with responses to disasters or “innovations” to any systems for that matter. It does seem like common sense that the CEO of a health insurance company that spends all its time and resources to avoid paying for people’s healthcare should’ve shown a little less hubris. (Of course elites always panic about the wrong things, even if it hurts their own interests, this is a known pattern.) I would’ve assumed that a person in that situation would be aware that the company is likely on the shitlist of any number of wronged and angry patients. But wait, there’s more - while some major media outlets have repeated the idea that this guy kept a “low profile” (do better, AP and PBS!), in fact in a newsletter from Payday Report, Mike Elk reported that this guy was being sued by Hollywood Firefighters union, saying “The union sued Thompson for failing to reveal that United Healthcare was under DOJ investigation. As a result, the pension fund lost $25 billion in value. Meanwhile, Thompson had cashed out over $15 million in stock while selling the stock to pension funds like those of the Hollywood Firefighters union.” and pointing to Ken Klippenstein’s report. So the list of people with axes to grind is numerous. Not what I’d describe as a low profile, but whatever.

The lack of judgement that stood out to me though was in another article which mentioned that: “At an investor meeting last year, he outlined UnitedHealth's shift to "value-based care," paying doctors and other caregivers to keep patients healthy, rather than focusing on treating them when they get sick.”

Who is Brian Thompson, the UnitedHealthcare CEO shot dead in Manhattan? By Megan Cerullo Edited By Anne Marie Lee Updated on: December 4, 2024 / 8:22 PM EST / CBS News For a top executive at a $562 billion company that affects how millions of Americans get health care, Thompson kept a relatively low profile. At an investor meeting last year, he outlined UnitedHealth's shift to "value-based care," paying doctors and other caregivers to keep patients healthy, rather than focusing on treating them when they get sick.

This “value based care” sounds quite obviously like a recipe to get doctors to fail to notice or even note any signs of serious disease. It sounds like an incentive to not document anything well, and to deliberately not notice any problems. Instead of being paid to cure and treat illness and relieve suffering, they would be incentivized to have patients with no sickness documented. Just sweep it under the rug! And if the patient dies, so be it because then they’re not a patient anymore and not covered by health insurance anymore, so they wouldn’t count in the metrics. And try to recruit mostly healthy people into your patient pools, and avoid taking on patients with chronic illness or any serious condition. Similar to the madness of “high risk pools” in privatized insurance. And already we have this problem with networks where some providers that are in-network are begrudging about it, and have their clerical staff make it as hard as possible to make an appointment if they have the “undesirable” insurance. I can’t prove this happens but it sure seems like it does since I’m not the only person who’s talked about running into this type of treatment and runaround when a specialist seems like they don’t want you as a patient even though they’re accepting new patients and supposedly are in-network.

Obviously an optimistic person might think that there would be an incentive just because not all patients die outright, and surely to mitigate downturns would be desirable. But that’s where loss aversion comes in, and also that market incentives are known for absolutely stinking at long-term goals, seemingly always favoring the short term. Andt if the patient takes a huge downturn and becomes disabled because of a preventable condition doctors failed to document, report, or treat, the patient will likely be shoved off the private healthcare insurance when they lose their job, and into Medicaid and maybe eventually Medicare, so then, again, not the problem of the private health insurance company. It’s all about socializing the losses and privatized profits.

I was astonished that this concept could be taken seriously given this glaringly obvious flaw. It’s so obvious that this would NOT be an improvement. Especially in the system we have that’s rife with perverse incentives already. I was relieved to find that Physicians for a National Health Program recognize the problem, and that there’s a published article from 2016 on the “countervailing incentives” and behavioral economics involved, and it articulates how the cognitive bias of loss aversion works so that people are more motivated to avoid loss than to seek gain. They didn’t articulate the gruesome corruption that I just envisioned. But anyone who’s worked in or adjacent to any kind of healthcare or health insurance in the trenches will know how the violence of the system plays out. It’s quite obvious this scheme would benefit the most lurid and ruthless of healthcare providers, and it would force even decent caring doctors into morally injurious situations as they would be pressured by employers to hide disease more than to prevent it or maintain health in patients. We already see how this works in these bureaucracies. If they’re looking for a solution to “upcoding”, which is a legitimate problem in the current payment system, then I suggest better oversight by patient advocacy oriented regulation makes sense. There’s no market solution here that would “naturally” benefit patients with the “invisible hand” they set up.

We need not just to let go of that idea, but to call it out, and reject it outright.

Lawsuit Against Murdered CEO - Firefighters pension accused UnitedHealthcare CEO of fraud, insider trading Ken Klippenstein Dec 04, 2024 In May, the Hollywood Firefighters’ Pension Fund had filed a lawsuit against Thompson, alleging he had sold over $15 million of UnitedHealth stock despite being aware of an active Justice Department antitrust investigation into the health insurance company that he did not disclose to investors or the public. Though UnitedHealth, the lawsuit alleges, was aware of the Justice Department investigation since at least October 2023, the public would only learn of the case when the Wall Street Journal published a story about it on February 27, 2024. When news of the investigation broke, it erased almost $25 billion in shareholder value. But by that time, Thompson had already cashed out, selling over $15 million in personally held UnitedHealth shares, per the suit. If true, the account affirms the countless internet memes’ depiction of Thompson as a rapacious health insurance executive fat cat. Literally none of the news media coverage I’ve seen about the murder has included this context, instead tugging at heart strings about the two sons he’ll be leaving behind. Members of Congress have likewise issued anguished statements about the tragic loss of life, remarks that decline to mention the allegations against him or the vast sums of money the company he oversaw has contributed to them and other politicians.

Behavioral economics and countervailing incentives in value-based payment - By Daniel R. Arnold Healthcare, May 17, 2016 But there is mounting evidence that extrinsic rewards can undermine intrinsic motivation. Of the numerous findings that relate to the crowd-out of intrinsic motivation, two seem particularly relevant to physicians: (1) negative effects of monetary rewards are strongest for complex cognitive tasks and (2) motivational crowd-out spreads to work that is not directly incentivized. With respect to complex cognitive tasks, even very large financial incentives undermine performance. For example, rural villagers in India offered half their annual money income experienced worsened performance on complex memory and puzzle-solving tasks. The spread of motivational crowd-out to work not directly incentivized has been observed in England. In 2004, the U.K. government introduced a pay-for-performance scheme with 136 indicators for family practices. By 2007, improvement for incentivized measures had plateaued, and quality deteriorated for two measures that were not incentivized.

PBS - Hacking Your Mind - Weapons of Influence Episode 102 | Marketers and politicians hack into your autopilot system — learn how to fight back. Aired 08/05/2020 | Expired 09/10/2024 | (transcript) One of the field's key insights is that gut feelings like loss aversion lead consumers to make predictable mistakes, and companies in a market economy make a lot of money by encouraging us to make those mistakes. Until then, the widely accepted view had been that markets actually protect consumers from their mistakes. “And so I would often hear something like the following -- "Yes, yes. I understand that the people in your experiments and some of the people I know do foolish things, but in markets, then -- and then I claim..." They could never quite finish this sentence without literally waving their hands, and the argument is somehow if you choose the wrong career or fail to save for retirement, that the market will somehow push you back toward being rational. There's a reason why no one can make this argument without waving their hands, and that's because the argument is just silly. You know, if you don't save enough for retirement, what happens to you? You're poor when you're old. The market doesn't discipline you. Suppose people have a weakness for gambling. What's going to happen? Will people build casinos, or will they offer programs to help people curb their gambling addiction? Well, people have made a lot more money on casinos than on programs to stop gambling.”

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🧠 Big Brother’s Beautiful Bill: How Trump and RFK Jr. Are Replacing Healthcare with Surveillance

By Rev. Dr. R. M. Anderson Introduction: When Healthcare Becomes a Trojan Horse Donald Trump’s administration recently rammed through what he triumphantly dubbed the “Big Beautiful Bill,” a sprawling piece of legislation promising to “save” rural healthcare. But dig beneath the glossy slogans, and you’ll find something far more sinister: a calculated dismantling of America’s health systems,…

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Are Medical Alert Systems the Missing Piece in Value-Based Care Models?

Across the whole U.S region, medical experts are adopting value-based care models. The overwhelming number of medical alert systems is generated by clinical decision support systems (CDSS). It has led to inappropriate alert overrides, that may lead to unintended patient harm. The value-based care is relevant to both patients whose healthcare comes via government programs, such as Medicaid, Medicare, and Veterans Health Administration facilities, and those who receive care privately. 

These systems, once regarded as emergency-only devices for the elderly, are now becoming a strategic asset in the broader shift toward proactive, patient-centered care. In this evolving narrative, C-suite leaders, startup entrepreneurs, and healthcare managers are re-evaluating the role of medical alert systems as a key lever in unlocking the full potential of value-based care.

The Convergence of Technology and Accountability

The transition from fee-for-service to value-based care models is fundamentally about accountability—hospitals and health systems are rewarded for keeping patients healthy, not just treating them when they're sick. This shift demands real-time data, early intervention, and patient empowerment. Herein lies the growing relevance of medical alert systems.

Modern medical alert systems go beyond panic buttons. With GPS tracking, fall detection, biometric monitoring, and seamless integration with electronic health records (EHR), these tools can serve as continuous health monitors. For chronic care patients—especially seniors living independently—this technology delivers critical health insights between clinical visits.

Bridging the Gap Between Clinical and Home-Based Care

One of the biggest challenges in value-based care is maintaining continuity beyond the hospital or doctor’s office. Patients, particularly those with chronic conditions, often experience health deterioration between scheduled appointments. Medical alert systems provide a solution by enabling round-the-clock monitoring that empowers early interventions.

According to a report by MarketsandMarkets, the global personal emergency response systems (PERS) market is expected to grow from $6.3 billion in 2022 to $9.4 billion by 2027, at a CAGR of 8.4%. This signals the growing role of these systems not only in personal safety but in structured healthcare delivery frameworks.

When connected to care management teams, medical alert systems can trigger alerts that allow healthcare providers to act before small issues escalate into hospital admissions. This proactive response fits seamlessly into the goals of value-based care: improving outcomes, reducing costs, and enhancing patient satisfaction.

ROI for Providers and Payers

Beyond patient health, medical alert systems can also generate measurable returns for providers and insurers participating in value-based care arrangements. Avoidable hospitalizations are costly—not only financially but in the context of performance-based metrics.

In a Kaiser Permanente study, implementation of remote patient monitoring tools led to a 50% reduction in hospital readmissions for heart failure patients. While not all remote tools are the same, medical alert systems can contribute to similar outcomes when used strategically within care plans.

Furthermore, these systems offer detailed incident reports and usage analytics that inform population health strategies. They can identify trends in patient behavior or symptoms, helping care coordinators adjust treatments or follow-up schedules.

Supporting the Aging Population

As the population ages, the demand for healthcare services will surge. A recent report by the Administration for Community Living projected that adults over 65 will make up 21.6% of the population by 2040. This demographic shift poses both a challenge and an opportunity for healthcare delivery models.

Medical alert systems are uniquely suited to serve this group. They enable aging individuals to remain in their homes longer without compromising their safety, aligning with the objectives of aging-in-place initiatives. By preventing injuries from becoming emergencies, these systems reduce reliance on acute care services and support population-level health improvements.

Integrating Medical Alert Systems Into Health IT Ecosystems

For healthcare leaders, the question is no longer whether medical alert systems are useful, but how to integrate them effectively into existing health IT ecosystems. Strategic partnerships with alert system providers are emerging as a key trend. These collaborations allow health systems to access data in real-time and deliver more personalized care.

Entrepreneurial startups are also entering the scene, offering white-labeled or co-branded alert solutions that can be customized to the needs of large healthcare providers. From wearable tech companies to AI-based monitoring platforms, innovation is reshaping how medical alert systems are perceived—and deployed.

Overcoming Adoption Barriers

Despite the promise, adoption isn’t without challenges. Issues related to interoperability, data privacy, and upfront costs can deter institutions from scaling medical alert systems programs. However, these hurdles are not insurmountable.

Forward-thinking healthcare managers are piloting small-scale programs with measurable KPIs. By demonstrating reductions in readmissions or improvements in patient adherence, these initiatives can justify broader investments.

Moreover, as Medicare Advantage plans expand their coverage of home-based technologies, the financial feasibility of deploying medical alert systems across larger populations is improving.

A Shift from Reactive to Predictive Care

Perhaps the most transformative impact of medical alert systems lies in their ability to shift care from reactive to predictive. Instead of waiting for patients to report issues—or worse, present at the emergency room—providers can intervene based on real-time alerts.

This model of care reduces provider burden, limits unnecessary utilization, and empowers patients to participate in their health management. For startup founders and C-suite decision-makers, the takeaway is clear: investing in the right alert technologies today can create outsized returns tomorrow.

Conclusion

As value-based care becomes the dominant paradigm in healthcare delivery, success will depend on how well providers extend their reach beyond traditional care settings. Medical alert systems offer a practical, scalable, and data-rich way to do just that.

They are not a silver bullet, but in combination with broader remote care and digital health initiatives, they may indeed be the missing piece that connects the dots in a fragmented care continuum. For business leaders, innovators, and healthcare executives aiming to create meaningful impact, it’s time to move medical alert systems from the periphery to the core of strategic planning.

Uncover the latest trends and insights with our articles on Visionary Vogues

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From Value-based Care to Values-based Care

During the SDOH/SIOH forum today, a key expert noted that for the last few years CMS has noted real concerns with the lack of ROI in value-based care models and perhaps time to rethink.Now clearly, there are many challenges and opportunities in this space, as highlighted in the terrific piece …“𝗟𝗲𝗮𝗱𝗶𝗻𝗴 𝗖𝗵𝗮𝗻𝗴𝗲: 𝗖𝗼𝗻𝗳𝗿𝗼𝗻𝘁𝗶𝗻𝗴 𝘁𝗵𝗲 𝗖𝗵𝗮𝗹𝗹𝗲𝗻𝗴𝗲𝘀 𝗼𝗳 𝗩𝗮𝗹𝘂𝗲-𝗕𝗮𝘀𝗲𝗱 𝗖𝗮𝗿𝗲 𝗛𝗼𝘄 𝗛𝗲𝗮𝗹𝘁𝗵 𝗦𝘆𝘀𝘁𝗲𝗺𝘀 𝗦𝗵𝗼𝘂𝗹𝗱 𝗘𝘃𝗮𝗹𝘂𝗮𝘁𝗲…

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How Value-Based Care is Reshaping Medical Billing Practices

Value-based care is transforming medical billing by prioritizing quality-driven reimbursements. By aligning payments with patient outcomes, healthcare providers can optimize financial performance while delivering superior care and maintaining compliance.

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ASCs and the Shift Towards Value-Based Care

Discover how value-based care in ASCs is enhancing patient outcomes and improving cost efficiency in healthcare. Read blog to know more about value-based care in ASC's

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Understand the principles of value-based oncology care and how it enhances patient outcomes by focusing on comprehensive, patient-centered treatment approaches. This model emphasizes coordinated care that minimizes unnecessary procedures and optimizes resource utilization, thereby ensuring quality treatment at reduced costs. By integrating evidence-based practices and involving interdisciplinary teams, value-based care aims to provide personalized care interventions that meet individual patient needs while improving overall healthcare efficiency.

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EXPLORING THE ROLE OF HEALTHCARE FINANCE IN DRIVING INNOVATION AND TECHNOLOGICAL ADVANCEMENT

EXPLORING THE ROLE OF HEALTHCARE FINANCE IN DRIVING INNOVATION AND TECHNOLOGICAL ADVANCEMENT 1.1 Introduction Healthcare finance plays a critical role in shaping the delivery of medical services and advancing innovations in healthcare. The integration of finance into the healthcare sector influences not only the quality and accessibility of services but also the adoption of new technologies. As…

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Revenue Cycle Management Market Analysis: Trends, Innovations, and 2024 Forecast Study

Global Revenue Cycle Management Market: Comprehensive Analysis and Future Outlook

The Global Revenue Cycle Management Market has been experiencing transformative growth, driven by the need for efficient financial management solutions across the healthcare industry. As healthcare providers face increasing financial pressures and evolving regulatory environments, revenue cycle management (RCM) systems have become essential tools for optimizing revenue collection, reducing errors, and enhancing overall operational efficiency.

Market Overview

The Global Revenue Cycle Management Market is anticipated to reach a value of USD 326.4 billion by 2024 and is projected to grow to USD 936.3 billion by 2033, reflecting a robust compound annual growth rate (CAGR) of 13.1%. This growth underscores the critical role of RCM solutions in the healthcare sector, which encompasses a broad range of services and software designed to streamline financial processes from patient registration to reimbursement.

Key Components of the Market

The market is primarily segmented into three key components:

RCM solutions aim to optimize patient care financial management by handling various tasks such as patient registration, eligibility verification, claims submission, and reporting. The goal is to reduce errors, speed up reimbursements, and enhance overall financial performance for healthcare organizations.

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Key Takeaways

Key Factors Influencing Market Dynamics

1. Technological Advancements

Advancements in technologies such as artificial intelligence (AI), machine learning (ML), and robotic process automation (RPA) are significantly impacting the RCM market. These technologies are driving automation, enhancing accuracy in coding, and improving claims processing efficiency. The integration of AI and ML enables predictive analytics and better decision-making, reducing operational costs and improving revenue collection.

2. Transition to Value-Based Care

The shift from fee-for-service to value-based care models is reshaping the demand for RCM solutions. Value-based care emphasizes efficiency and outcomes over the volume of services provided. RCM solutions are crucial for managing the complexities of outcome-based reimbursement structures, making them essential for healthcare organizations adapting to these new models.

3. Regulatory Changes

The ever-evolving regulatory landscape, especially in regions like North America, drives the demand for adaptable RCM solutions. Changes in billing, coding, and compliance regulations necessitate systems that can quickly adapt to new standards, ensuring continued compliance and minimizing audit risks.

4. Data Security and Privacy

With the digitization of healthcare processes, data security and patient privacy have become paramount. RCM solutions must comply with stringent data protection regulations to safeguard sensitive healthcare information. Providers prioritize vendors who ensure robust data security measures and adhere to privacy regulations.

5. Cost of Implementation

The high cost of acquiring and implementing RCM systems can be a barrier for smaller healthcare facilities. In addition to initial acquisition costs, ongoing maintenance and training expenses can be significant. This cost consideration influences the adoption rate of RCM solutions, particularly among smaller practices.

6. Integration Challenges

Integrating RCM solutions with existing healthcare information systems, such as electronic health records (EHRs), presents challenges. Compatibility issues, data transfer complexities, and interoperability concerns are major factors affecting the seamless implementation of RCM systems.

7. Emerging Markets

Expanding healthcare infrastructure in emerging markets presents significant growth opportunities for RCM providers. As these markets develop and improve healthcare coverage, the demand for advanced RCM technologies to optimize revenue cycles and financial performance increases.

8. Shift Towards Cloud-Based Solutions

Cloud-based RCM solutions are gaining traction due to their scalability, flexibility, and cost-effectiveness. These solutions offer remote accessibility, reducing the need for substantial infrastructure investments and providing automatic updates and enhanced disaster recovery capabilities.

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Targeted Audience

The Global Revenue Cycle Management Market serves a diverse range of stakeholders within the healthcare industry, including:

Recent Developments

1. Allscripts Healthcare Sale (May 2023)

Allscripts Healthcare LLC concluded the sale of its Hospital and Large Physician Practices business segment to Constellation Software Inc. This move was aimed at refining its focus and enhancing its service offerings.

2. CareCloud and Google Cloud Partnership (July 2023)

CareCloud Inc. partnered with Google Cloud to integrate generative AI into its RCM solutions, targeting improved operational efficiency and capabilities for small and medium-sized healthcare providers.

3. Optum and Owensboro Health Collaboration (July 2023)

Optum and Owensboro Health established a strategic partnership to enhance revenue cycle management and information technology, focusing on improving patient outcomes and safety.

4. Athenahealth Acquisition (February 2022)

Athenahealth was acquired by affiliates of Bain Capital and Hellman & Friedman from Veritas Capital and Evergreen Coast Capital, marking a significant shift in ownership and strategic direction.

5. Nym's Medical Coding Engine Expansion (October 2022)

Nym expanded its medical coding engine to radiology departments across the United States, enhancing coding accuracy and efficiency.

6. Olive’s Autonomous Revenue Cycle (June 2022)

Olive introduced its Autonomous Revenue Cycle (ARC), a suite of advanced RCM solutions designed to optimize revenue cycle management processes.

Conclusion

The Global Revenue Cycle Management Market is poised for substantial growth, driven by technological advancements, regulatory changes, and the increasing complexity of healthcare financial management. As the industry transitions towards value-based care and embraces digital transformation, RCM solutions will play a critical role in optimizing revenue cycles, ensuring compliance, and enhancing financial performance for healthcare organizations.

With a projected market value of USD 936.3 billion by 2033 and a CAGR of 13.1%, the RCM market represents a significant opportunity for stakeholders across the healthcare ecosystem. Key trends, such as the shift towards cloud-based solutions and the integration of AI and ML technologies, will continue to shape the landscape, offering new avenues for growth and innovation.

FAQs

1. What is the expected growth rate of the Global Revenue Cycle Management Market?

The Global Revenue Cycle Management Market is expected to grow at a CAGR of 13.1% from 2024 to 2033.

2. What are the key components of the Revenue Cycle Management Market?

The key components include software solutions, services, and end-users such as healthcare providers and payers.

3. Which delivery mode is projected to dominate the market?

The web-based delivery mode is expected to dominate the market, holding a 54.9% share in 2024.

4. What are the major factors influencing the RCM market dynamics?

Key factors include technological advancements, the transition to value-based care, regulatory changes, data security concerns, and cost of implementation.

5. Who are the primary end-users of RCM solutions?

Primary end-users include healthcare providers, payers, and other entities involved in revenue cycle management and financial operations in healthcare.

The Global Revenue Cycle Management Market presents a dynamic and evolving landscape, reflecting the critical role of financial management solutions in the healthcare sector. As technological innovations and regulatory changes continue to drive the market, stakeholders must stay informed and adaptable to harness the full potential of RCM solutions.

About Us

Dimension Market Research (DMR) is the ultimate one-step solution to all your research needs and requirements. Dimension Market Research is India and US based company, we have headquarters in USA (New York) with offices in Asia pacific region. Dimension Market Research is specifically designed to provide most relevant syndicated, customized and tailor made market research to suit your specific business needs. 

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Three Value-Based Care Takeaways from the APG Annual Fall 2023 Conference

For three days at the end of October and beginning of November, health practitioners, population health professionals, and healthcare technology experts from around the nation converged on Washington, DC for the America’s Physician Group (APG) Annual Fall Conference. One of the biggest topics of discussion was the transition to value-based care. Presenters and participants shared their experiences with value-based care, the challenges they are facing, and strategies to succeed in this transformative era of healthcare. This content originally published here https://www.episource.com/resources/three-value-based-care-takeaways-from-the-apg-annual-fall-2023-conference-2/

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What Is Value-based Care?

Value-based care is a payment system that incentivizes quality and cost outcomes, rather than merely rewarding procedures or volume of care. Value-based care emphasizes patient health outcomes over speed and quantity of services, with incentives to improve both the value and the economics of healthcare delivery.

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Friday Feature: Quality and the Revenue Connection (2019 version)

I’ve written a lot over the years about understanding the unique connection between quality care and the systems to support its delivery, and revenue. Arguably, the most successful provider organizations understand that impeccable quality of care (delivery, outcomes, patient satisfaction) begets high occupancy (referrals) and preferential payer mix (quality mix). Of course, the inverse…

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Blitzen in number 16: Falling Short

For the color challenge, please and thank you ♡

color palettes

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ASCs and the Shift Towards Value-Based Care

Discover how value-based care in ASCs is enhancing patient outcomes and improving cost efficiency in healthcare.

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If there's any explanation/clarification needed feel free to go with it in the tags/replies. It's not flawless.