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For years, the U.S. has consistently spent more on healthcare than other nation, to a tune of more than $14,800 per person in 2024 — more than 2.5 times the average as calculated by the Organisation for Economic Co-operation and Development.
Despite this massive investment, almost half of Americans say it’s difficult to afford healthcare costs, with 36% of adults reporting they have skipped or postponed getting care in the past 12 months due to cost concerns.
While the high prices of the American healthcare system are certainly a factor in today’s healthcare woes, the problem doesn’t lie in the cost of services alone.
It’s found in the way care is delivered and paid for.
Traditional healthcare models often prioritize volume over value, which can lead to unnecessary treatments or overlooked health risks. Meanwhile, people from underserved communities face even greater barriers to care, widening gaps in health equity and outcomes.
As a response, today’s health systems and plan designers are increasingly embracing value-based care strategies, through which all stakeholders in the care journey can experience a reduction in costs without compromising access to high-quality care — a movement that Vālenz Health® is proud to support with innovative, industry-leading solutions.
Table of Contents
- What is Value-Based Care? Understanding the Future of Healthcare
- Benefits of Value-Based Care
- Shifting to Value-Based Care Strategies with Vālenz Health®
- Design Your Value-Based Health Plan Today
What is Value-Based Care? Understanding the Future of Healthcare
The American approach to healthcare has long been a reactive one: Care often doesn’t begin until after a person is sick, which leads to diagnoses caught at later stages, higher overall costs, and worse care outcomes.
A value-based care model takes a different approach, prioritizing proactive, preventive, and patient-centered strategies that focus on overall well-being and long-term outcomes.
In a traditional fee-for-service model, providers are reimbursed based on the volume of services delivered. A value-based approach ties payments to the quality of the services delivered, with providers earning incentives for providing care that improves health outcomes and controls costs.
Key Principles of Value-Based Care
A value-based approach follows several core principles that influence how care is delivered and measured.
- Preventive Care and Early Intervention: By identifying and treating health issues before they become more serious, value-based care supports better patient outcomes while reducing the need for high-cost treatments, specialists, and hospitalizations.
- Value over Volume: Providers are evaluated and reimbursed based on patient outcomes instead of the number of services performed, which encourages more personalized, meaningful, and productive interactions with patients.
- Personalized Approach to Care: Value-based care takes each member’s specific needs, preferences, and goals into account to determine treatment strategies, in contrast to a one-size-fits-all approach.
- Team-Based Approach: Value-based healthcare is often led by the primary care physician who, in tandem with services like care navigation and case management, guide patients through chronic conditions, appointment scheduling, and engagement with their treatment plan.
- Data Transparency: Care decisions are informed by patient data shared across the care team, who use that information to identify care gaps and encourage follow-through on preventive screenings, prescriptions, and annual exams.
- Holistic View of Care and Health: A value-based approach to care recognizes that well-being goes beyond the doctor’s office and is influenced by a variety of factors such as housing, education, income, and access to nutritious food — all of which are discussed and incorporated as part of a value-based treatment plan.
Benefits of Value-Based Care
Healthcare is becoming increasingly expensive, and one of the top influencing factors is the traditional fee-for-service model. Because providers are paid based on the number of services performed, they may order additional, unnecessary tests and procedures in line with a “more is better” perspective.
By requiring those services to be directly tied to positive outcomes, a value-based model minimizes unnecessary care, resulting in cost savings, reduced waste, and more value from healthcare choices — supporting providers and patients in making more informed, cost-effective decisions based on data.
Lower Healthcare Costs
With its focus on prevention and early intervention, value-based care helps avoid the high costs associated with late-stage disease and unnecessary treatments — in turn reducing out-of-pocket costs for members and overall spend for plan sponsors.
By engaging early and often with high-risk populations, value-base care strategies have been proven to reduce hospitalizations by 32% among Medicare Advantage patients, for a total estimated savings of $11 billion — a 25% decrease compared to Original Medicare.
Providers who work within a value-based care system are encouraged to use lower-cost, higher-quality treatment methods — for example, eliminating duplicative tests and relying on evidence-based care plans — to reduce overall waste.
At the same time, patients are guided to cost-efficient care choices — for example, seeking care via telehealth options rather than emergency rooms, or choosing generic rather than specialty prescription medication — with proactive case management and care navigation.
Together, these strategies could generate tens of billions of dollars of savings in high-cost specialties like oncology and cardiology, which contribute to a significant proportion of American healthcare spend.
Better Healthcare Outcomes
As a value-based care model reduces the costs of late-stage diagnosis and complex care needs, it also reduces the negative care outcomes associated with those challenges to support healthier lives.
In addition to reducing hospitalizations and ER visits, value-based care models have been proven to improve preventative care uptake (in the form of cancer screenings) and treatment adherence for chronic diseases such as diabetes and hypertension. Elderly patients enrolled in care navigation (a foundational feature of value-based care) also reported higher health-related quality of life scores, as well as improvements in depression and anxiety scores.
In other words, by identifying and treating patients in a more proactive manner, value-based care helps to reduce risks earlier in a member’s journey, providing intervention that supports smarter, sustainable care choices and healthier populations.
Improved Health Equity
People from disadvantaged backgrounds often face barriers to care that can result in higher rates of illness and shorter life expectancy. Many are less likely to have a usual source of care or regularly receive timely preventive services, which contribute to higher rates of serious health conditions.
With a value-based approach, providers are better prepared to address the causes of these health inequities by engaging early to meet patients where they are in their health journeys.
For example, care navigators who provide personalized guidance can resolve issues of provider distrust, empowering vulnerable communities to take charge of their own healthcare journeys and, as a result, improving outcomes for those underserved populations.
With the level of data analysis made possible by value-based care, healthcare plans and providers can also better identify at-risk populations early on, connect them to supportive programs and services in their areas, and develop a level of trust only made possible through personalized, results-oriented care.
Increased Employee Satisfaction
Americans have long viewed the healthcare system with derision and frustration, as indicated by the 53% who feel they’re treated “more like a number than a person” when accessing necessary care.
In contrast, a value-based care model creates a better experience for patients with a personalized, outcomes-focused approach that puts their needs first.
Value-based care strategies empower members to take charge of their personal care journeys: selecting a high-value provider that meets their needs, shopping for cost-efficient facilities, incorporating alternative care options such as telehealth visits, etc.
As a result, members in value-based care arrangements consistently report higher satisfaction scores and better overall experience, including stronger care coordination and communication, than traditional fee-for-service models.
Shifting to Value-Based Care Strategies with Vālenz Health®
According to a study by United Healthcare, nearly 90% of employers plan to invest in some type of value-based strategy in 2026.
Valenz is supporting that shift for many self-funded employers with proactive solutions that engage members across the entire care journey for higher-value, lower-cost healthcare decision making.
Valenz Bluebook: Price & Quality Transparency
As a comprehensive cost and quality solution, Valenz Bluebook supplies data for more than 4,000 facilities and 500,000 providers to navigate members to high-quality, low-cost options for their care needs.
With a “green-yellow-red" color-coding rating system, the Valenz Bluebook platform simplifies the healthcare search for members, designating “Fair Price™” labels to those providers who have proven to deliver the highest-quality care for the best price.
Our Engagement Rewards feature offers even more reasons for members to select high-value care. Those who shop for and select Fair Price providers can receive cash rewards (via debit card or HSA/HRA contributions), creating a positive feedback loop that supports future use of the platform and smarter care choices.
In offering an unparalleled amount of trusted provider data straight to members, Valenz Bluebook cuts through the complexity of today’s healthcare ecosystem to put decision-making power directly in member hands — supporting member literacy and cost containment for the plan.
Valenz Precision Care: Guided Healthcare Navigation
By combining proactive navigation, data-driven insights, and integrated bundled solutions, Valenz Precision Care delivers personalized member guidance for complex surgeries and treatments — encouraging the choice of high-value facilities and providers to reduce cost and improve member outcomes.
In alignment with value-based care principles, Precision Care leverages multiple data sources to identify and support members facing specialized and advancing surgical procedures. Member services staff engage early and often with members to connect them with the right providers at the right time, reducing stress and improving health outcomes.
As a result, members are given the support they need to make smarter, more cost-efficient choices for traditionally expensive procedures, minimizing the ultimate medical spend for all involved.
Valenz Variable Copay: Rewards for Value-Based Choices
The Valenz Variable Copay solution takes the power of Valenz Bluebook one step further in promoting value-based care choices: by assigning lower copays to providers deemed high-value by a plan.
Our solution maps common medical procedures to clear, predictable copays, highlighting in-network providers who deliver the highest value for the lowest cost. As a result, members are actively guided toward providers that meet value-based care standards in a cost-sharing model that lowers individual and total plan spend.
Variable Copay eliminates the financial guesswork and confusion associated with traditional fee-for-service models. Clear, transparent upfront cost estimates help members understand their copays before receiving care; lower-cost options incentivize smarter choices by placing the financial responsibility in the member’s hands.
And, unlike other variable copay models, our solution goes beyond simple implementation to educate members about the tools and resources available to them — maximizing program uptake for an average 7–12% employer savings.
ValenzONE: A Singular Solution for a Value-Based Strategy
A value-based care model works best when deployed across the member care journey. ValenzONE combines all of the solutions above (and more) to deliver that all-encompassing benefits strategy to support smarter, better, faster healthcare for all involved.
As an innovative health plan optimization platform, ValenzONE transforms the entire member experience with early engagement and a streamlined path to high-value care options — delivering better care outcomes and lower plan spend in one easily implemented solution.
Learn more about the features available with ValenzONE — and the potential savings for your organization — by contacting one of our team members below.
Design Your Value-Based Benefits Plan Today
With healthcare prices going nowhere but up, and research disproving the “more expensive is better” paradigm, now is the time for plan sponsors to reject traditional healthcare models in favor of innovative approaches that are better designed for the challenges of the future.
For many, that answer can be found in a value-based care model.
Benefit plan designs that prioritize proactive, preventive, and patient-centered care strategies will be the leading choice for forward-thinking employers, third-party administrators, and brokers in the years to come. By containing costs while simultaneously protecting member access to high-quality care, value-based care models hold the potential to completely transform the healthcare industry.
Valenz can help your organization get in on the ground floor of this paradigm shift. Our comprehensive value-based solutions will optimize the cost, quality, and utilization of healthcare for your entire plan with a plan design tailored to your unique population and organizational needs.
Learn more or get started today by contacting one of our team members below.
