It’s a win-win-win: Maximizing healthcare ROI with fee-for-service, value-based care, and automation

The healthcare industry is making the push toward greater adoption of value-based care, motivated by pressures from payers and a drive for better patient experience and outcomes. As healthcare systems plan for the future, the CMS estimates that nearly all hospitals will operate under a value-based care model by 2030. The shift also has incredible upside, with McKinsey forecasting that continued traction in the value-based care market could lead to $1 trillion in enterprise value for payers, providers, and investors.

However, this gradual shift to a new model of care opens a chasm between “now” and “then,” creating an in-between where health systems must navigate both fee-for-service and value-based care models while also addressing existing challenges caused by labor shortages, administrative burdens, and shrinking margins. 

Fortunately, one solution provides a “win-win-win” across all fronts as the healthcare industry manages this transition: intelligent automation. 

Triple alignment: VBC, FFS, and automation

Automation enables health systems to win now and set themselves up for future success by driving efficiency and performance improvements across multiple business lines, from the contact center to revenue cycle management. 

“Whether you’re operating under a value-based care model or a fee-for-service model, at the end of the day, your organization will benefit significantly from streamlined workflows,” says Dave Henriksen, Head of Value Based Care at Notable. “Addressing inefficient work that can result in readmissions or leakage will make your organization more successful now, while also providing a smoother runway for any change management over the next few years.”

A proven AI platform is the key to this transition, providing one integrated solution for automating present and future workflows. By investing in a platform now, healthcare systems gain flexibility, scalability, and enhanced performance no matter what direction they pursue next.  

Driving ROI across all lines of business

To begin automating capabilities in the shift to value-based care, healthcare leaders should address the business areas that will improve performance in both value-based care (VBC) and fee-for-service (FFS) models. This includes: 

• Care management and quality. Readmissions can negatively affect both value-based care and fee-for-service systems. By automating workflows like chart scrubbing, post-discharge follow-ups, and care management enrollment, VBC systems can reduce readmissions and eliminate the manual work needed to close gaps. FFS organizations can also reduce readmission penalties and drive greater use of owned facilities.

• Contact center. Contact centers serve as the frontline of the patient experience, but they require high numbers of staff and are limited by traditional working hours. Automated flows for inbound and outbound enquiries regarding scheduling, billing, and medication refills improve the patient experience and free up staff time. For VBC, this translates into enhanced quality performance and patient satisfaction while extending operational hours without increasing labor costs. FFS models benefit from increased visit revenue, higher growth and acquisition of patients, and optimized labor efficiency.

• Revenue cycle. Automated workflows for prior authorizations, HCC chart review, and compliance audits also provide substantial value under both models. Under VBC, these processes improve labor efficiency and compliance while ensuring patients receive appropriate care faster. This contributes to better health outcomes—a pay-for-performance metric. Under FFS, the same automations drive timely revenue collection, fewer write-offs, and improved treatments for all conditions.

• Patient access. Patient care can be delayed by backlogged manual work queues across referral transcription and management, eligibility verification, and registration. By automating these tasks in a VBC model, providers can achieve higher patient satisfaction and quicker turnaround times. Under FFS, automating these tasks can result in decreased revenue leakage, improved operational performance, and the assurance that patients are completing their care plans.

• Chart abstraction. Chart abstraction and provider quality audits are typically labor-intensive tasks prone to human error. By automating these functions, health systems gain access to high-quality data for performance analytics and compliance verification. Under a VBC model, this leads to better decision-making and outcome-driven care. Under a FFS model, it enables efficient labor usage and higher compliance with billing standards, optimizing overall claim acceptance rates.

“Investing in automation is the best decision a healthcare organization can make right now,” adds Henriksen. “There’s no better way to control costs and maintain financial stability while still ensuring your patients are getting the right care, at the right time.”

A unified vision for the future

While value-based care and fee-for-service models have distinct differences, health systems benefit from better patient outcomes and stronger revenue cycles. 

The real power lies in implementing intelligent automation, which empowers healthcare providers to deliver high-quality care while still maintaining costs—it no longer needs to be a choice between operational efficiency and patient satisfaction.