We’ve been working to move towards value-based care for a while now, but there are still some kinks we need to work out to have it run the way we all want it to. One such kink is trying to decipher if the problems we are having in value-based care are on the tech side of healthcare or if they are policy issues.
We reached out to our brilliant Healthcare IT Today Community to ask — how much of value-based care is a tech problem and how much is a policy problem? The following are their answers.
Jay Ackerman, CEO at Reveleer
Policy sets the direction for value-based care (VBC), but the real barriers are largely operational and technological. While the vision is clearly policy-driven, most challenges come down to fragmented systems, inconsistent data practices, and outdated processes that make execution difficult. In that sense, it’s less a question of motivation and more a matter of building the right tools and workflows to make the policy goals achievable. Policy defines what will happen, but technology determines whether it can happen at scale.
Kevin Riley, Co-CEO at Tendo
Value-based care is fundamentally both a technology and a policy challenge—and success requires progress on both fronts. Policy establishes the incentives and frameworks that define what “value” means, but technology determines whether those goals can be operationalized at scale. Policies may mandate coordinated, outcome-driven care, but without interoperable systems, data liquidity, and user-friendly workflows, even the best-designed models falter.
Sanjeev Menon, Head of Provider Solution at Ubie
As much as I’d love to say technology can solve everything, policy is the biggest barrier to moving to a true value-based system. Technology evolves to meet needs, and needs are defined by incentives. Today’s healthcare ecosystem has too many misaligned incentives, so in many ways, tech is exacerbating the biggest challenges in VBC. Payers and providers are locked in the Coding Wars with payers’ upcoding & revenue cycle management tools forcing insurers to adopt ever more draconian downcoding tools – and vice versa.
Ultimately, VBC comes down to paying for quality, which depends on two policy questions: 1) who pays? and 2) what’s quality? Tech only helps once we answer those questions.
Taylor Beery, Co-Founder and Chief Innovation & Administrative Officer at Imagine Pediatrics
Value-based care is ultimately about the impact of improving outcomes and experiences for the patients we serve. Across the US health system, we find ourselves in a moment where providers and health plans can achieve much better outcomes than at any other time in history with the right technology.
The role of policy here is to ensure the right incentives and structure for tech-enablement, dismantling the fragmentation that has stood in the way of access to integrated and personalized care for far too long. Policy changes should start with vulnerable populations, like children with special healthcare needs. Those policy changes should align the systems, data, and incentives around the lived experience of patients and opportunities for impact, not just codes and transactions.
Susan Lofton, MPT, VP, Outcomes and Clinical Transformation at WebPT
Value-based care is roughly 60% policy and 40% tech. While policy mandates the shifts and defines the rules and requirements, technology is what enables providers to execute, measure, and report under those rules. Why 60% policy and 40% tech? You can’t ‘tech’ your way around bad policy, but even good policy fails without the right tools.
Steve Holt, Vice President, Government Affairs at PointClickCare
Value-based care (VBC) is less a single challenge and more a policy–technology alignment problem. The policy framework defines what outcomes and incentives matter, while technology determines whether and how those outcomes can be measured, shared, and acted upon in real time. Many healthcare organizations today, especially those that received HITECH funding, are technologically equipped to participate in value-based care.
However, the roadblocks to VBC come in the form of inconsistent alignment of federal and state definitions of “value,” varied data-sharing standards and requirements across payers, and the administrative complexity of participation. For example, post-acute and long-term care providers are largely excluded from incentive programs that would fund the connectivity and allow them to participate fully in VBC. However, revisiting state and federal quality incentive programs that focus on technology adoption and improved technology-driven outcomes would be a significant catalyst in increasing VBC adoption across the care continuum.
Linda Leigh Brock, Vice President of Product Management at NASCO
Value-based care (VBC) started as a policy-driven innovation, but its biggest barriers today are technological. Policy can mandate change, yet true progress depends on having the right data, analytics, and workflows to make value-based models work. Adoption has been slow due to the lack of longitudinal data, action-ready clinical workflows, and transparent economics.
Technology, especially predictive analytics, must enable better patient engagement, proactive interventions, and standardized outcome tracking. However, applying advanced tools to outdated fee-for-service (FFS) processes risks reinforcing the wrong system. Real success requires using technology to build new, purpose-built value-based care workflows rather than optimizing legacy ones.
Julie Sacks, CEO at Home Centered Care Institute
In my opinion, value-based care needs serious policy change. While technology can support care coordination, data sharing, and remote monitoring, it’s policy that determines who can participate, how care is reimbursed, and whether incentives are aligned across the continuum. Smaller practices, especially those serving frail, elderly, and homebound patients, often lack the scale or infrastructure to thrive under current models. Without inclusive payment pathways (like High Needs ACO REACH), these providers risk being left out of the value-based care movement.
To truly realize the promise of value-based care, we need policy reform that prioritizes flexibility, inclusivity, and outcomes that matter to patients.
Lucienne Ide, Founder & Chief Executive Officer at Rimidi
Value-based care is both a policy design challenge and an implementation and execution problem, and it’s not possible to succeed without addressing both. Policy sets the incentives and guardrails, while technology and workflow redesign make them operational at the point of care. Over the past few years, CMS policy has clearly moved in the right direction with decisions to encourage care management activities — such as RPM and CCM — and to introduce models that reward outcomes-focused care rather than episodic encounters.
Where organizations stumble isn’t a lack of policy; it’s the translation layer. Many core barriers stem from technology gaps: fragmented data, limited interoperability across EHRs and HIEs, poor care coordination workflows between specialists and primary care, and underdeveloped analytics that don’t operationalize risk.
Policy is perhaps 30-40% of the problem today. The remaining 60-70% is execution, largely getting the right data in the right workflow for the right clinician at the right time, and doing it consistently enough to improve readmissions, adherence, and total cost of care. You can count on policy to open the door, but technology determines whether providers actually walk through it.
Frank Vega, CEO at The Efficiency Group
Value-based care breaks down when policy goals and operational reality don’t meet. In these situations, technology is often deployed to address the “disconnect” when the real issue is the operational process executing the policy. The policy – and the process – need to be clear in order for the technology to be effective. The intent is there, but without clean workflows, structured data, and automation, even the best policies and technologies stall before they reach the patient.
Mary Sirois, Senior Vice President, Strategic Solutions at Nordic
Getting value-based care right is not a matter of whether tech or policy matters more, but rather, which must come first. Value-based care (VBC) succeeds or fails on an organization’s ability to understand and manage risk, and that can be heavily—but not entirely—influenced by policy. A health system’s ability to absorb shifts in policy (coverage, performance metrics, stability, tariffs, payment models, etc.) while maintaining responsible stewardship for quality of care, outcomes management, and understanding cost across the continuum of care activities is a prerequisite for VBC success.
Tech, on the other hand, is an accelerator and an enabler. It can speed up and enable progress, but it doesn’t fix weak cost discipline, poor quality data, or suboptimized workflows that fail to capture or utilize data to best measure and perform against the contract, and its efficiency gains alone aren’t a substitute. If a health system can’t manage unit costs and operational complexity, it won’t survive in a risk-bearing model, full stop.
VBC is good in theory, but it can be a losing bet for many mid-to-small hospitals right now as payer mix shifts toward Medicare, Medicaid churn pushes people into the uninsured bucket, and supply tariffs drive up input costs. Technology can absolutely help, but only after leaders confront the macroeconomics.
David Snow, CEO at Cedar Gate Technologies
On the policy side, the first mandatory alternative payment model is launching in 2026 (the Transforming Episode Accountability Model, or TEAM) and experts agree that additional mandates are likely on the horizon. Until now, value-based care has been largely voluntary, and organizations that didn’t see it as profitable enough could simply continue to operate in fee-for-service models. As the government shifts toward mandatory participation, commercial insurers are expected to follow CMS’s lead.
On the technology side, success in value-based care really hinges on the ability to bring data together in a cohesive, interoperable way—a challenge that has long plagued healthcare, but health IT systems are now capable of addressing in a meaningful and effective way.
Shitang Patel, VP, Payers at CitiusTech
Value-based care is less a pure technology or policy problem and more a systemic operating-model problem. Technology has contributed to fragmentation. Organizations have built “a quilt of patchwork” across Stars, HEDIS, readmissions, risk adjustment, and population health, each with its own tools, dashboards, and workflows that don’t always talk to each other.
At the same time, policy complexity from CMS and private payers has created overlapping and sometimes contradictory requirements, such as demanding value-based outcomes while still measuring physicians on RVU productivity. Prior authorization and payer-specific barriers further impede standardized care pathways and add friction to clinical workflows.
The real divide is not tech vs. policy; it’s that both have evolved independently without a unified governance model. We built scaffolding for a new care paradigm, but forgot the concrete. Until incentives, workflows, and data flows are aligned, both technology and policy will continue to underdeliver.
What great insights 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.
How much of value-based care do you think is a tech problem, and how much do you think is a policy problem? Let us know over on social media, we’d love to hear from all of you!
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