Growth Opportunities in US Digital Health Solutions as an Enabler for Value-based Care

Growth Opportunities in US Digital Health Solutions as an Enabler for Value-based Care

Robust Investments and Disruptive Technological Innovation Transforming Care Delivery

RELEASE DATE
19-Dec-2023
REGION
North America
Deliverable Type
Market Research
Research Code: K965-01-00-00-00
SKU: HC_2023_425
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Description

According to the Centers for Medicare and Medicaid Services (CMS), value-based care (VBC) programs reward healthcare providers with incentive payments for the quality of care they provide Medicare patients.

These programs are part of its larger CMS quality strategy to reform healthcare delivery and payment. Value-based programs support 3 aims: better care for individuals, better health for populations, and lower cost of care. This study analyzes digital health solutions for payers and providers (including physician practices and hospitals) that enable VBC programs. It excludes solutions targeting life sciences, pharmaceutical companies, and the public sector. Evaluations are exclusive to the United States, with concept considerations based on the CMS.

The study addresses the current status of value-based programs and payment incentives by CMS, such as ACO REACH, MSSP, MCP, and AHEAD models, alongside regulatory updates and growth opportunities for the next five years. It additionally assesses the role of digital health providers and payers in digital quality measurements and performance gaps, showcasing best practices from established US companies and start-ups enabling VBC through digital health solutions.

Author: Delfina Huergo

Table of Contents

Why is it Increasingly Difficult to Grow?

The Strategic Imperative 8™

The Impact of the Top 3 Strategic Imperatives on the US Value-based Care (VBC) Industry

Growth Opportunities Fuel the Growth Pipeline Engine™

Scope of Analysis

Market Segmentation

Payment Incentives—CMS VBC Models

Payment Incentives—Accountable Care Models

Payment Incentives—Accountable Care Models (continued)

Payment Incentives—Accountable Care Models: Medicare Shared Savings Program (MSSP)

Payment Incentives—Accountable Care Models: Medicare Shared Savings Program (MSSP) (continued)

Payment Incentives—Accountable Care Models: ACO Realizing Equity, Access, and Community Health (ACO REACH) Model

Payment Incentives—Accountable Care Models

Payment Incentives—Disease-specific and Episode-based Models

Payment Incentives—Disease-specific and Episode-based Models (continued)

Payment Incentives—Disease-specific and Episode-based Models (continued)

Payment Incentives—Medicare Access and CHIP Reauthorization Act of 2015 (MACRA): Merit-based Incentive Payment System (MIPS)

Payment Incentives—MACRA: Alternative Payment Models (APMs)

VBC Programs and Legislation

VBC Programs and Legislation (continued)

How to Measure Quality?

How to Measure Quality?—The 6 Healthcare Quality Priorities

How to Measure Quality?—Digital Health’s Role

How to Measure Quality?—Payer’s Role

Addressing Gaps in Performance Measurement

Addressing Gaps in Performance Measurement (continued)

Addressing Gaps in Performance Measurement (continued)

Addressing Gaps in Performance Measurement (continued)

Addressing Gaps in Performance Measurement (continued)

Addressing Gaps in Performance Measurement (continued)

Established US Companies and Start-ups Enabling VBC through Digital Health Solutions

Established US Companies and Start-ups Enabling VBC through Digital Health Solutions (continued)

Established US Companies and Start-ups Enabling VBC through Digital Health Solutions (continued)

Established US Companies and Start-ups Enabling VBC through Digital Health Solutions (continued)

Growth Drivers

Growth Restraints

Growth Opportunity 1: Standardization of Digital Quality Measures (dQMs)

Growth Opportunity 1: Standardization of Digital Quality Measures (dQMs) (continued)

Growth Opportunity 2: Behavioral Health and Telehealth Investment

Growth Opportunity 2: Behavioral Health and Telehealth Investment (continued)

Growth Opportunity 3: Small and Medium Practices Demand

Growth Opportunity 3: Small and Medium Practices Demand (continued)

Growth Opportunity 4: Generative AI for Physician Burnout

Growth Opportunity 4: Generative AI for Physician Burnout (continued)

List of Exhibits

Legal Disclaimer

According to the Centers for Medicare and Medicaid Services (CMS), value-based care (VBC) programs reward healthcare providers with incentive payments for the quality of care they provide Medicare patients. These programs are part of its larger CMS quality strategy to reform healthcare delivery and payment. Value-based programs support 3 aims: better care for individuals, better health for populations, and lower cost of care. This study analyzes digital health solutions for payers and providers (including physician practices and hospitals) that enable VBC programs. It excludes solutions targeting life sciences, pharmaceutical companies, and the public sector. Evaluations are exclusive to the United States, with concept considerations based on the CMS. The study addresses the current status of value-based programs and payment incentives by CMS, such as ACO REACH, MSSP, MCP, and AHEAD models, alongside regulatory updates and growth opportunities for the next five years. It additionally assesses the role of digital health providers and payers in digital quality measurements and performance gaps, showcasing best practices from established US companies and start-ups enabling VBC through digital health solutions. Author: Delfina Huergo
More Information
Deliverable Type Market Research
Author Delfina Huergo
Industries Healthcare
No Index No
Is Prebook No
Keyword 1 Digital Health Trends
Keyword 2 Value-Based Care Insights
Keyword 3 Healthcare Technology Forecast
Podcast No
WIP Number K965-01-00-00-00