Value-based care is a healthcare model designed to prioritize quality, provider performance, and the patient experience, according to the Centers for Medicare & Medicaid Services (CMS). This approach, which shifts focus away from the quantity of care provided, aims to improve health for populations and lower costs for individuals and the healthcare system.
Holistic Patient Management
Under value-based care, healthcare providers work together to manage a person's overall health while considering an individual's personal health goals. This model emphasizes integrated care, which addresses a person's physical, mental, behavioral, and social needs rather than focusing solely on a specific disease or health issue.
By treating patients as whole persons, providers can identify potential obstacles to care, such as limited access to reliable transportation, healthy food, or stable living conditions. This method also allows for more convenient care management; for example, doctors may coordinate blood work so a patient only needs to visit a clinic once.
Patient Experience Benefits
Patients may experience several specific benefits under this model, such as easier navigation of their care through assigned care coordinators. These coordinators can contact patients between medical visits to check on their progress following a procedure or to help solve issues encountered during treatment.
Additional benefits include access to educational resources regarding specific health issues, more flexible options for communicating with providers, and opportunities to participate in disease prevention programs for conditions like heart disease or diabetes. CMS notes that individuals participating in these programs retain all current Medicare benefits and can continue to see any doctor who accepts Medicare.
CMS Program Framework
The CMS Innovation Center utilizes pilot programs known as models to test the most effective ways to implement this type of care. These models are designed to prompt doctors to communicate more effectively across different practices and appointments to reduce care fragmentation.
CMS also utilizes several established value-based programs to link provider performance with payment. These include the Hospital Value-Based Purchasing Program, the Hospital Readmission Reduction Program, and the End-Stage Renal Disease Quality Incentive Program. Other programs include the Skilled Nursing Facility Value-Based Purchasing and Home Health Value-Based Purchasing programs.
Utah Health Plan Oversight
In Utah, health plan quality and satisfaction are monitored to help consumers make informed decisions. As of April 22, 2026, the Utah Department of Health and Human Services (DHHS) reported that the Health Care Statistics Program collects information regarding the quality of services provided by Medicaid Managed Care contractors, CHIP health plans, and commercial insurance companies.
This data is published through the Utah Health Plan Quality of Care Report (HEDIS), which provides performance information for consumers and purchasers. Additionally, the annual Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey is used to assess patient experiences with health plans.
Systemic Healthcare Reform
The overarching goal of value-based programs is to move the healthcare industry toward rewarding providers based on the quality of care rather than the volume of services. This strategy is part of a larger effort to reform how healthcare is both delivered and paid for, focusing on better care for individuals and better health for entire populations.
