Most Influential Government Policies and Potential Policy Changes in Value-Based Care

With value-based care still being on the relatively newer side of healthcare, there is still a lot of policy that is being put in place or policy that needs editing. For a deeper insight into some of those policies, we reached out to our brilliant Healthcare IT Today Community to ask — what government policies are going to be the most influential when it comes to value-based care? What changes to policy would you like to see to accelerate the move to value-based care? Below are their answers.

Taylor Beery, Co-Founder and Chief Innovation & Administrative Officer at Imagine Pediatrics
The most influential policies for value-based care will be those that strengthen programs like Medicaid and reward measurable impact. When policy removes unnecessary administrative barriers and funds proactive, integrated care instead of volume, it creates the foundation for real change. We can see this clearly in pediatrics, where policies that support early, preventive care improve outcomes and lower costs for children with special healthcare needs. To accelerate the shift to value-based care, we need policies that measure and pay for what works – personalized care that integrates medical, behavioral, and social support.

AJ Patel, CEO at TeleMed2U
The goal of value-based care is simple, make it easier to get paid for better outcomes, not just more visits. While CMS programs like ACO REACH, Primary Care First, and the recently launched Rural Health Transformation Program will continue driving these models, acceleration is key. In order to move faster, policymakers should simplify and standardize reporting across payers, make it easier for specialty telehealth providers to join value-based contracts, and finally, expand data sharing, which needs to start with giving smaller groups the help they need to build the tech infrastructure to support this initiative.

Jay Ackerman, CEO at Reveleer
Policies from CMS and other agencies continue to impact the transition to value-based care, especially through programs that link payment models to quality and outcomes. Moving forward, policies that promote data interoperability, consistency in reporting standards, and stronger alignment across Medicare and Medicaid systems will be most impactful. Accelerating progress will require focusing not only on compliance but on improving data quality, accessibility, and integration across the care ecosystem. Ultimately, policies that reward data-driven collaboration will do more to accelerate value-based care than any single mandate.

Joey Kennedy, SVP Sales at Tendo
Policies that strengthen interoperability, incentivize outcomes over volume, and reduce administrative burden will have the most lasting impact. Continued evolution of CMS models—such as expanding shared savings programs, advancing risk adjustment methodologies, and encouraging cross-sector collaboration—will be pivotal.

Looking ahead, accelerating value-based care will depend on policies that prioritize data transparency, reward equity and access, and foster public-private partnerships. Policymakers can further drive adoption by ensuring smaller or rural providers have the support—technical and financial—to participate fully. The goal should be not just more value-based programs, but more equitable participation and measurable impact across the entire healthcare ecosystem.

Susan Lofton, MPT, VP, Outcomes and Clinical Transformation at WebPT
CMS payment models drive everything – e.g., MIPS, ACO structures, and APMs set the tone that commercial payers follow. As such, these policies will continue to steer the market when it comes to value-based care. Policy changes that would help accelerate the movement to value-based care will likely be those that the CMS Innovation Center Strategy recently announced, including promoting (and paying for) evidence-based prevention, empowering people to achieve their goals, and driving choice and competition. These pillars are foundational to set the motion towards value in care as they incentivize early proactive care, where patients are enabled to be able to choose what is most meaningful to them and where they derive the most benefit.

David Snow, CEO at Cedar Gate Technologies
The upcoming TEAM mandate will be crucial as organizations move toward alternative payment models like capitation and bundled payments—after many decades of voluntary participation in VBC-oriented programs, mandated participation is going to be the only way that we can move those goals forward in a meaningful way. Those who invest early in integrated, VBC-focused IT systems will be best positioned to comply with TEAM requirements and thrive under whatever value-based care reimbursement models come next.

As policy shifts from voluntary to mandatory participation, commercial payers are likely to follow suit, so organizations that are prepared to implement VBC in every population (not just their Medicare and Medicaid populations) will be the most likely to see long-term sustainability and success.

Andrew Mackenzie, FSA, CERA MAAA, Chief Science Officer at Arbital Health
The government has really led the push to value-based care, and CMS has set an objective that by 2030, all Medicare spend will run through some type of financial risk arrangement. We can go back to the Affordable Care Act and the establishment of CMS’s Innovation Center (CMMI) and all of its associated Alternative Payment Models, like MSSP and ACO Reach, or even further back to the Medicare Modernization Act of 2004, which CMS established VBC mechanisms and influenced the program’s future.

Beyond direct VBC contributions, when CMS makes policy updates like changing the HCC model version or how reinsurance works in Part D (via the Inflation Reduction Act), it frequently has a huge impact on existing payer-to-provider VBC deals. In the near-to-mid term, we should expect more government support for provider financial risk, incentive alignment, direct primary care, and price transparency, which will all impact VBC deals, as well as foster more VBC growth and evolution.

Shitang Patel, VP, Payers at CitiusTech
CMS remains the most influential policy driver for value-based care. Frameworks such as the Health Care Payment Learning and Action Network (HCPLAN) were designed to reduce cost variability and align payment with health outcomes. Policies that enforce prior authorization, sustain RVU-based productivity measures, or layer multiple reporting structures create friction that undermines VBC goals.

Overall, medical expenses are relatively higher than normal, and these will increase with the anticipated decrease in insurance coverage (Medicaid, ACA). The cumulative impact of uninsured and underinsured will put more pressure to reduce medical expenses, and value-based care models are one way to try and curtail high MLRs. More advanced value-based care models (e.g., shared savings with upside and downside risk) as well as specialty-focused models (e.g., Oncology, Cardiology) will be of greater focus.

Policy changes that would accelerate progress include simplifying and harmonizing quality programs, aligning payment incentives with long-term outcomes rather than short-term utilization, and reducing administrative barriers that force clinicians into workarounds.

Julie Sacks, CEO at Home Centered Care Institute
Government policy is the single most powerful lever in accelerating the shift to value-based care. Programs like High Needs ACO REACH are beginning to address the needs of high-cost, high-need populations—particularly frail, elderly, and homebound patients who often fall through the cracks of traditional care models. These individuals account for nearly half of Medicare spending, yet many lack access to consistent primary care and spend their final years experiencing repeated emergency room visits, costly hospital stays, and consistent readmissions.

To truly move the needle, we need policies that expand and sustain alternative payment models (APMs), especially those that support home-based primary care, hospital-at-home, and team-based care coordination. Congress must extend APM incentive payments and reduce administrative burdens that prevent smaller practices from participating.

Ultimately, policy must empower providers and patients to jointly decide the best place of service—whether that’s in the home, clinic, or community—based on need, not billing codes. The future of value-based care depends on payment structures that reward health, quality care, positive patient experience, and patient outcomes.

Reva Sheehan, Senior Vice President of Health Solutions at DUOS
The CMS Interoperability & Prior Authorization Final Rule (CMS-0057-F) is a policy that may lessen some of the persistent burdens that interfere with value-based care by streamlining and standardizing data sharing. This final rule will force healthcare organizations to invest in IT infrastructure and adopt new practices and access. The unification of quality measures across all lines of business and payers will reduce provider burdens and improve care based on clinical needs and factors, rather than payer strategies.

The same goes for reporting requirements – when there is standardization across systems for HEDIS, MIPS, ACO, and more. It not only relieves administrative burdens but also offers better insights and data into populations and areas of need.

As for changes to policy, they must continue to be progressive but cannot outpace the actual ability or accessibility for all involved parties to participate properly. If we have systems and groups with extreme inequities in funding and technical infrastructure, we’re only creating more disparities amongst what are likely already underserved individuals and communities.

Jason Prestinario, CEO at Particle Health
Put plainly, the most influential step the government can take to advance value-based care is enforcing information blocking rules to stop EHRs and health systems from hoarding patient medical records. In a fee-for-service model, understanding what’s happening to a patient across their entire care journey is helpful, but it’s mission-critical in value-based care. Beyond information blocking, we also need policies that recognize that payers who are working to keep patients healthy should have the same right to access patient data as providers do. Policies should democratize healthcare data for the benefit of patients, period.

Shay Perera, Co-Founder & CTO at Navina
The continued push toward downside-risk models, digital quality measurement, and interoperability standards will shape the next few years of VBC. Policies that improve data liquidity, particularly around claims timeliness and interoperability, have an outsized impact on clinical performance. What would accelerate adoption is reducing the administrative variability across programs. When every contract defines quality differently, the operational burden becomes unsustainable. Aligning measures and simplifying documentation requirements would let clinicians focus on care rather than compliance.

So many great answers 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 government policies do you think are going to be the most influential when it comes to value-based care? What changes to policy would you like to see to accelerate the move to value-based care? Let us know over on social media, we’d love to hear from all of you!

With value-based care still being on the relatively newer side of healthcare, there is still a lot of policy that is being put in place or policy that needs editing. For a deeper insight into some of those policies, we reached out to our brilliant Healthcare IT Today Community to ask — what government policies are going to be the most influential when it comes to value-based care? What changes to policy would you like to see to accelerate the move to value-based care? Below are their answers.

Taylor Beery, Co-Founder and Chief Innovation & Administrative Officer at Imagine Pediatrics
The most influential policies for value-based care will be those that strengthen programs like Medicaid and reward measurable impact. When policy removes unnecessary administrative barriers and funds proactive, integrated care instead of volume, it creates the foundation for real change. We can see this clearly in pediatrics, where policies that support early, preventive care improve outcomes and lower costs for children with special healthcare needs. To accelerate the shift to value-based care, we need policies that measure and pay for what works – personalized care that integrates medical, behavioral, and social support.

AJ Patel, CEO at TeleMed2U
The goal of value-based care is simple, make it easier to get paid for better outcomes, not just more visits. While CMS programs like ACO REACH, Primary Care First, and the recently launched Rural Health Transformation Program will continue driving these models, acceleration is key. In order to move faster, policymakers should simplify and standardize reporting across payers, make it easier for specialty telehealth providers to join value-based contracts, and finally, expand data sharing, which needs to start with giving smaller groups the help they need to build the tech infrastructure to support this initiative.

Jay Ackerman, CEO at Reveleer
Policies from CMS and other agencies continue to impact the transition to value-based care, especially through programs that link payment models to quality and outcomes. Moving forward, policies that promote data interoperability, consistency in reporting standards, and stronger alignment across Medicare and Medicaid systems will be most impactful. Accelerating progress will require focusing not only on compliance but on improving data quality, accessibility, and integration across the care ecosystem. Ultimately, policies that reward data-driven collaboration will do more to accelerate value-based care than any single mandate.

Joey Kennedy, SVP Sales at Tendo
Policies that strengthen interoperability, incentivize outcomes over volume, and reduce administrative burden will have the most lasting impact. Continued evolution of CMS models—such as expanding shared savings programs, advancing risk adjustment methodologies, and encouraging cross-sector collaboration—will be pivotal.

Looking ahead, accelerating value-based care will depend on policies that prioritize data transparency, reward equity and access, and foster public-private partnerships. Policymakers can further drive adoption by ensuring smaller or rural providers have the support—technical and financial—to participate fully. The goal should be not just more value-based programs, but more equitable participation and measurable impact across the entire healthcare ecosystem.

Susan Lofton, MPT, VP, Outcomes and Clinical Transformation at WebPT
CMS payment models drive everything – e.g., MIPS, ACO structures, and APMs set the tone that commercial payers follow. As such, these policies will continue to steer the market when it comes to value-based care. Policy changes that would help accelerate the movement to value-based care will likely be those that the CMS Innovation Center Strategy recently announced, including promoting (and paying for) evidence-based prevention, empowering people to achieve their goals, and driving choice and competition. These pillars are foundational to set the motion towards value in care as they incentivize early proactive care, where patients are enabled to be able to choose what is most meaningful to them and where they derive the most benefit.

David Snow, CEO at Cedar Gate Technologies
The upcoming TEAM mandate will be crucial as organizations move toward alternative payment models like capitation and bundled payments—after many decades of voluntary participation in VBC-oriented programs, mandated participation is going to be the only way that we can move those goals forward in a meaningful way. Those who invest early in integrated, VBC-focused IT systems will be best positioned to comply with TEAM requirements and thrive under whatever value-based care reimbursement models come next.

As policy shifts from voluntary to mandatory participation, commercial payers are likely to follow suit, so organizations that are prepared to implement VBC in every population (not just their Medicare and Medicaid populations) will be the most likely to see long-term sustainability and success.

Andrew Mackenzie, FSA, CERA MAAA, Chief Science Officer at Arbital Health
The government has really led the push to value-based care, and CMS has set an objective that by 2030, all Medicare spend will run through some type of financial risk arrangement. We can go back to the Affordable Care Act and the establishment of CMS’s Innovation Center (CMMI) and all of its associated Alternative Payment Models, like MSSP and ACO Reach, or even further back to the Medicare Modernization Act of 2004, which CMS established VBC mechanisms and influenced the program’s future.

Beyond direct VBC contributions, when CMS makes policy updates like changing the HCC model version or how reinsurance works in Part D (via the Inflation Reduction Act), it frequently has a huge impact on existing payer-to-provider VBC deals. In the near-to-mid term, we should expect more government support for provider financial risk, incentive alignment, direct primary care, and price transparency, which will all impact VBC deals, as well as foster more VBC growth and evolution.

Shitang Patel, VP, Payers at CitiusTech
CMS remains the most influential policy driver for value-based care. Frameworks such as the Health Care Payment Learning and Action Network (HCPLAN) were designed to reduce cost variability and align payment with health outcomes. Policies that enforce prior authorization, sustain RVU-based productivity measures, or layer multiple reporting structures create friction that undermines VBC goals.

Overall, medical expenses are relatively higher than normal, and these will increase with the anticipated decrease in insurance coverage (Medicaid, ACA). The cumulative impact of uninsured and underinsured will put more pressure to reduce medical expenses, and value-based care models are one way to try and curtail high MLRs. More advanced value-based care models (e.g., shared savings with upside and downside risk) as well as specialty-focused models (e.g., Oncology, Cardiology) will be of greater focus.

Policy changes that would accelerate progress include simplifying and harmonizing quality programs, aligning payment incentives with long-term outcomes rather than short-term utilization, and reducing administrative barriers that force clinicians into workarounds.

Julie Sacks, CEO at Home Centered Care Institute
Government policy is the single most powerful lever in accelerating the shift to value-based care. Programs like High Needs ACO REACH are beginning to address the needs of high-cost, high-need populations—particularly frail, elderly, and homebound patients who often fall through the cracks of traditional care models. These individuals account for nearly half of Medicare spending, yet many lack access to consistent primary care and spend their final years experiencing repeated emergency room visits, costly hospital stays, and consistent readmissions.

To truly move the needle, we need policies that expand and sustain alternative payment models (APMs), especially those that support home-based primary care, hospital-at-home, and team-based care coordination. Congress must extend APM incentive payments and reduce administrative burdens that prevent smaller practices from participating.

Ultimately, policy must empower providers and patients to jointly decide the best place of service—whether that’s in the home, clinic, or community—based on need, not billing codes. The future of value-based care depends on payment structures that reward health, quality care, positive patient experience, and patient outcomes.

Reva Sheehan, Senior Vice President of Health Solutions at DUOS
The CMS Interoperability & Prior Authorization Final Rule (CMS-0057-F) is a policy that may lessen some of the persistent burdens that interfere with value-based care by streamlining and standardizing data sharing. This final rule will force healthcare organizations to invest in IT infrastructure and adopt new practices and access. The unification of quality measures across all lines of business and payers will reduce provider burdens and improve care based on clinical needs and factors, rather than payer strategies.

The same goes for reporting requirements – when there is standardization across systems for HEDIS, MIPS, ACO, and more. It not only relieves administrative burdens but also offers better insights and data into populations and areas of need.

As for changes to policy, they must continue to be progressive but cannot outpace the actual ability or accessibility for all involved parties to participate properly. If we have systems and groups with extreme inequities in funding and technical infrastructure, we’re only creating more disparities amongst what are likely already underserved individuals and communities.

Jason Prestinario, CEO at Particle Health
Put plainly, the most influential step the government can take to advance value-based care is enforcing information blocking rules to stop EHRs and health systems from hoarding patient medical records. In a fee-for-service model, understanding what’s happening to a patient across their entire care journey is helpful, but it’s mission-critical in value-based care. Beyond information blocking, we also need policies that recognize that payers who are working to keep patients healthy should have the same right to access patient data as providers do. Policies should democratize healthcare data for the benefit of patients, period.

Shay Perera, Co-Founder & CTO at Navina
The continued push toward downside-risk models, digital quality measurement, and interoperability standards will shape the next few years of VBC. Policies that improve data liquidity, particularly around claims timeliness and interoperability, have an outsized impact on clinical performance. What would accelerate adoption is reducing the administrative variability across programs. When every contract defines quality differently, the operational burden becomes unsustainable. Aligning measures and simplifying documentation requirements would let clinicians focus on care rather than compliance.

So many great answers 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 government policies do you think are going to be the most influential when it comes to value-based care? What changes to policy would you like to see to accelerate the move to value-based care? Let us know over on social media, we’d love to hear from all of you!