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The US health care system is increasingly moving towards value-based care to promote improved health outcomes for Americans. This can be seen across Medicare Advantage Plans (MA Plans), Accountable Care Organizations (ACOs), and Certified Community Behavioral Health Centers (CCBHC), among others. This movement also demands a transformation of reimbursement models to value-based contracting, with a focus on sharing risk across stakeholders and controlling costs to improve patient health.
Organizations successfully producing value-based health outcomes rely on integrated data and information systems that support the key functionality required to coordinate and manage care. Their infrastructure is designed to manage: 1) the members of a covered population; 2) the providers, facilities, and other organizations that provide care; 3) the care team and coordination of care; and 4) the adjudication of services and the tracking and reporting of health outcomes.