From delivering holistic patient care to helping providers avoid unnecessary costs to leveraging non-clinical assets to bridge care gaps, these companies are leading the shift to value-based care.
The transition from the fee-for-service (FFS) to the value-based care (VBC) model is critical to the ongoing transformation of the US healthcare system.
In the VBC model, healthcare providers are paid for the healthcare outcomes of their patients, rather than just for services provided.
Since it was signed into law in 2010 as part of the Affordable Care Act, “value-based care” and related initiatives — such as “care coordination” and “social determinants of health” — have attracted increasing media attention.
Heading into 2020, 67% of Humana’s individual Medicare Advantage members were cared for by primary care providers with value-based arrangements. Further, about 85% of Cigna’s Medicare Advantage network physicians are in value-based payment arrangements, as of October 2020.
Several regulatory announcements have also increased momentum in the space: For example, regulators recently announced changes to the “Stark law” — a rule preventing physicians from referring patients to any entity with which they have a financial relationship — allowing providers more flexibility in forming outside relationships to pursue value-based goals.
Additionally, the Department of Health and Human Services (HHS) has proposed changes to the HIPAA Privacy Rule that would expand individuals’ rights to access their digital health information and enhance data interoperability, which could improve patient care coordination and further value-based reimbursements.
Using the CB Insights platform, we surfaced 150+ private companies facilitating the value-based care transformation and mapped them according to 7 categories within the space, from social determinants of health to value-driven providers.
This market map consists of private, active companies only and is not intended to be exhaustive of the space. Categories are not mutually exclusive, and companies are mapped according to primary use case.
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