Technology is a vast umbrella term that covers so many aspects in healthcare, ranging from the smaller side, like healthcare apps and personal wearable devices, to the larger side, like artificial intelligence and precision medications. This makes it very difficult to be aware of all the technology in healthcare and how it’s useful in all of the many aspects of healthcare. So today, we are going to narrow this wide field down by focusing our attention on the technologies that are helpful in aligning payer and provider goals.
We reached out to our incredible Healthcare IT Today Community to ask — what role does technology play in aligning payer and provider goals around value-based care and quality measurement? Below are their responses.
Kempton Presley, CEO at AdhereHealth
Facilitating shared visibility, decision support, and interpretation, technology is essential to aligning payer and provider goals in value-based care. Data integration with advanced analytics flags members who are nonadherent, overdue for screenings, or trending toward higher utilization—allowing teams to prioritize outreach and close multiple quality gaps in a single interaction. That precision improves efficiency and strengthens shared accountability.
But technology isn’t the strategy. It’s the tool. AI can flag that a prescription wasn’t picked up; without proper training, the model can’t reliably uncover why. Human insights regarding transportation barriers, cost-driven refill delays, or a patient’s choice of groceries over medications require an emotional quotient that a generative model cannot emulate. Those insights require conversation, trust, and personal judgment. In value-based care, analytics surface shared risks to each stakeholder, but empathy and behavioral expertise from payor and provider constituents alike turn data into adherence, quality improvement, and lasting outcomes.
Lindsay Porter, VP of Coding and Clinical Solutions at AGS Health
Technology doesn’t just support VBC; it is the instrumental link between payers and providers to make alignment scalable and sustainable. Interoperable platforms, EHR integrations, FHIR standards, and advanced analytics create a unified “single source of truth” from clinical, claims, social determinants, and other data sets. This interoperability builds trust, reduces silos, and enables real-time tracking of key metrics like HEDIS scores, STAR ratings, and care gaps.
AI and predictive tools further support this alignment by automating gap closure, risk stratification, clinical decision support, and administrative tasks (e.g., prior authorizations), which shifts the focus to high-value care. Intentional integration will lead to the ultimate shared goal: better population health, lower costs, improved patient experience, and provider satisfaction.
Carol Skenes, Chief of Staff & Principal Regulatory Strategist at Turquoise Health
VBC and quality measurements are often tied to longer episodes of care that involve multiple appointments, providers, and types of care. For example, an orthopedic surgery episode may involve multiple consults, imaging, pre-op, the actual surgery, and a series of post-op appointments. Technology allows for a comprehensive view of those appointments to help ensure patients are getting the right level of treatment and minimize the risk of complications or readmissions.
As far as reimbursing these episodes of care, I also view technology as the solution to simplifying care bundles. Right now, VBC care and quality are tracked across each of the services and appointments using proprietary codes; however, an open source singular code for the entire episode of care can help simplify tracking, payment, and goals alignment to encourage more VBC and episodic-based contracts between payer and providers.
Kengo Takishima, Chairman and CEO at Baylor Genetics
Genomic sequencing technology, such as rapid whole genome and whole exome sequencing, can play a pivotal role in aligning payer and provider goals because of its ability to deliver timely genetic insights that can be vital to support accurate diagnoses and more personalized patient care.
For patients with rare or undiagnosed diseases, their genes often hold the key to getting the answers they need. Access to genomic sequencing from the beginning can provide insights that inform a clearer diagnosis earlier in the care journey – ultimately supporting more targeted medical management decisions, connecting families to the right specialists, guiding long-term care planning, and improving quality of patient care and outcomes.
For value-based care, that speed and accuracy can translate directly into measurable impact: accelerated time-to-diagnosis and improved outcomes, fewer unnecessary appointments and procedures, avoidance of ineffective treatments, and reduced long-term costs across the system. In that way, genomic sequencing technology serves as a powerful bridge between providers focused on clinical excellence and payers focused on sustainable, outcomes-driven care.
Theo Koury, MD, President at Vituity
Technology plays a critical role in aligning payer and provider goals because it creates shared visibility into both clinical outcomes and the operational drivers of cost. In value-based care, alignment depends on transparency, efficiency, and trust across the ecosystem. Payers and providers ultimately want the same outcome: high-quality care delivered sustainably.
One of the greatest barriers to achieving that goal is administrative complexity. Healthcare bureaucracy is estimated to account for 15%–30% of total national health expenditures, meaning hundreds of billions of dollars tied to manual processes, redundant workflows, and fragmented or inaccurate information. Thoughtfully deployed technology can help address this challenge. Automation, interoperable data systems, and real-time analytics reduce administrative friction, improve data accuracy, and streamline processes like quality reporting, authorization workflows, and performance measurement. When both payers and providers are working from the same reliable data, quality metrics become clearer and incentives align.
Technology also enables proactive care through decision support and predictive insights that help clinicians intervene earlier and reduce unnecessary utilization. Real progress requires collaboration, and technology alone cannot solve misalignment. It must be implemented through shared accountability between payers, providers, and technology partners working toward better outcomes and a more efficient healthcare system.
Carney Taylor, MD, MBA, Chief Medical Officer at Interwell Health
Technology is critical to aligning payer and provider goals in value-based care because it creates a shared, longitudinal view of the patient and embeds quality into everyday practice. In kidney care, data is fragmented across specialties and venues of care. If we can’t connect that information, we can’t proactively manage risk or consistently perform against quality measures. That’s why we collaborate with payers to aggregate and analyze data across the continuum and present it in a way that follows the patient—so providers can intervene earlier to improve outcomes and reduce total costs of care.
Just as important, technology has to fit the workflow. We can’t expect clinicians to log into another platform. Quality insights must be embedded directly in the EHR at the point of care to surface care gaps, recent hospitalizations, and next-best actions in the moment decisions are made. When predictive analytics and population health tools are integrated into a nephrology-focused system, quality measurement becomes part of care delivery, not a separate reporting exercise.
Payer and provider alignment is also built on trust and transparency. Our technology is built to address the needs of our payer and provider partners, and our AI tools operate in secure environments with full traceability following human-in-the-loop principles. The goal is to augment clinical judgment, not replace it, to enable exactly the kind of personalized, proactive, and efficient care that value-based models are designed to reward.
Jeff Bennett, Chief Strategy and Innovation Officer at Modivcare
Technology plays a central role in aligning provider and payer goals in today’s healthcare environment. Interoperable remote monitoring solutions give clinical teams a clear and consistent view of members’ health journeys, while equipping payers with data and insights to measure care plan effectiveness that happens outside of the traditional clinical setting. With a data-driven foundation, both parties can clearly define and track care quality and ensure measurable health outcomes are aligned with value-based care.
Data and care insight accessibility within a coordinated care ecosystem allows providers to deliver more proactive care while fostering better alignment around quality improvement across the industry. Ultimately, this translates to quantifiable improvements in both member outcomes and total cost of care, and ensures that value-based care benefits providers, payers, and members alike.
Suhas Ramachandra, VP Product Strategy & Innovation at ZeOmega
Technology has become the execution layer of value-based care. It must translate contract terms, quality measures, and utilization policies into real-time, actionable workflows that connect clinical activity to financial performance. When payers and providers operate from a shared, normalized data model, alignment improves, and accountability becomes measurable, not theoretical.
Stephen Vaccaro, President at HHAeXchange
In home care, technology is essential to aligning payer and provider goals around value-based care and quality measurement. Because care is delivered in the home rather than a facility, consistently measuring quality depends on real-time documentation. When caregivers record point-of-care observations using interoperable systems that are connected to payers and state Medicaid programs, they ensure everyone is operating from the same central data set. That shared visibility makes it easier to track outcomes, monitor adherence to care plans, and reflect reimbursement for the quality of care delivered.
Technology also strengthens the operational processes behind value-based reimbursement. When documentation, authorizations, quality reporting, and billing are connected instead of managed separately, agencies can reduce administrative workloads and better align their operations with payer requirements. Timely, accurate data improves billing reliability and helps prevent reimbursement delays. Integrated technology syncs care delivery and payments by making quality tracking a part of everyday operations rather than an added reporting requirement.
Elevsis Delgadillo, SVP, Customer Success at KeenStack
Technology is foundational for enabling true value-based alignment. Predictive analytics help forecast patient health risks, utilization, and cost trends so both payers and providers can act proactively. AI-powered decision support reduces variability at the point of care, while risk stratification and care gap identification directly connect quality outcomes to financial performance.
Monte Sandler, Chief Operating Officer at WebPT
Technology allows providers to automate the complexity that historically required heavy manual oversight. AI can manage thousands of payer-specific rules, coding combinations, and exceptions simultaneously, which reduces friction in the revenue cycle. When administrative waste goes down, and payment becomes more predictable, both providers and payers benefit operationally. That alignment supports broader goals around efficiency and value.
Kevin Ruane, Practice Leader, Analytic Advisory at Truven
Healthcare organizations increasingly recognize that effective claims management, utilization review, and care coordination require a truly holistic analytics strategy. Members are more than a single metric—clinical, behavioral, social, and financial health all intersect to shape outcomes. That’s why leading payer–provider ecosystems are moving beyond siloed datasets and embracing diverse sources, from clinical records and social risk indicators to financial data and program participation.
To unlock member insights, it is now essential to use an analytics platform that integrates all data sources. These integrated, multiple perspectives power advanced machine learning models, as organizations gain a clearer, more actionable view of cost drivers, care needs, and member engagement in healthcare. The result is more accurate interventions, utilization decisions, and care pathways that improve both affordability and the member experience.
Dan McDonald, Co-Founder and CEO at 86Borders
Technology plays a critical and supportive role in aligning payers and providers around value-based care and quality metrics like Centers for Medicare & Medicaid Services (CMS) Star Ratings and the Healthcare Effectiveness Data and Information Set (HEDIS). Data platforms can identify care gaps, stratify risk, and flag members who are overdue for screenings, or managing complex chronic conditions, behavioral health, and/or social determinants of health (SDOH) barriers.
It is important to note that the real alignment happens when those insights are paired with human-centered outreach. Simply sending automated reminders often leads to message fatigue and disengagement. When care coordinators use technology to prioritize outreach — establish a “human-to-human” conversation, then build trust, address immediate barriers, and coordinate with providers — quality scores improve, unnecessary utilization declines, and both payer and provider performance goals are met more effectively.
Derek Plansky, SVP Governance & Solutions at Health Gorilla
Technology plays a critical role in aligning payer and provider goals under value-based care. It makes quality measurement and utilization insights more efficient, transparent, and actionable. Interoperable data infrastructure enables clinical, quality, and administrative data to be used consistently across organizations. This shifts the focus from collection to outcomes and enables more confident performance measurement.
Julie Scherer, President and Chief Solutions Officer at Motive Medical Intelligence
Evidence-based clinical analytics focused on waste, appropriateness, and quality of care are a key technology for aligning payer and provider goals in value-based care, a holy grail we are trying to universally achieve in the U.S. health system. Clinical analytics systems that measure individual physician performance deliver expert insights that align payers’ cost-reduction priorities with providers’ commitment to appropriate, high-quality care. By analyzing settled claims data against established standards-of-care guidelines, these systems identify unnecessary, inappropriate, and wasteful care — a critical component of value-based alignment and success.
So many great points to consider here! Huge thank you to everyone who took the time out of their day to submit a quote to us! And thank you to all of you for taking the time out of your day to read this article! We could not do this without all of your support.
What role do you think technology plays in aligning payer and provider goals around value-based care and quality measurement? Let us know over on social media, we’d love to hear from all of you!
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