Enabling Providers to Track and Report Quality Metrics and Outcomes Required for Value-Based Care Reimbursement

A system in which providers are only reimbursed based on improved patient outcomes and quality care is what value-based care is all about. Rewarding the providers for what they should be doing and not the amount of tests they run or services provided. This helps put the emphasis on the patient’s well-being and also helps to reassure the patient that the tests being run are necessary and not because the hospital wants more money. As wonderful as this system is, it only works if providers can track and report the quality metrics and outcomes. But how do they do that?

We reached out to our talented Healthcare IT Today Community to ask — how can healthcare IT tools enable providers to track and report quality metrics and outcomes required for value-based care reimbursement? Where is this not happening, but it should be? Below are their responses.

Eric Makovsky, EVP Solutions at Tendo
Healthcare IT tools should make quality measurement seamless and meaningful, not burdensome. The right systems integrate data capture into clinical workflows, ensuring metrics are derived from care delivery itself rather than from manual reporting after the fact. This kind of automation allows clinicians to spend less time on documentation and more time on patient care.

Where this isn’t happening, it’s often because of fragmented data ecosystems, a lack of interoperability, or systems designed primarily for billing rather than outcomes. In these environments, the burden of data aggregation and reporting falls to the providers themselves—creating frustration and inefficiency. The future of quality reporting lies in real-time, embedded analytics that connect insights directly to the point of care.

Daniel Vreeman, DPT, Chief Standards Development Officer and Chief AI Officer at HL7 International
Value-based care depends on both smart policy and smart plumbing. Payment reform sets the incentives, but interoperable technology unlocks our ability to actually measure, exchange, and act systematically on the data that defines value. Open data standards make it possible to share quality metrics, care gaps, and outcomes data in real time across payers, providers, and patients. Without an interoperable data infrastructure, even the best policy design can’t deliver the coordination and accountability that value-based care demands.

Patty Hayward, General Manager of Healthcare and Life Sciences at Talkdesk
Value-based care isn’t just about changing payment models; rather, it’s about transforming every patient interaction into an opportunity for better outcomes. By using AI to turn contact centers into proactive value centers, providers can close care gaps in real time, improve population health, and achieve the financial and clinical goals of value-based contracts. When technology enables empathy, at scale, then value follows naturally.

Ling Shao, Founder of SpectrumAI and SVP of Outcome-Based Care at CentralReach
Outcomes-based care within specialty areas, such as autism care, often faces a shortage of standardized methods rather than a lack of data available to showcase progress and desired outcomes. Providers are eager to showcase the progress their patients have made, yet lack the standards and technology needed to communicate outcomes to payers at the aggregate level. This leaves important data in silos and providers struggling in the face of a broken fee-for-service system.

As a former health plan professional and a mother of four children on the spectrum, I’ve experienced the flaws with a fee-for-service model firsthand. This model fails to align payment to the incentives that everyone is seeking – better outcomes. At a time when providers face a litany of challenges, we must ask ourselves: Why are we creating this additional financial hurdle for providers?

Practices and providers need to lean into advanced technology and healthtech partners to communicate their outcomes to payers in a standardized, consistent manner. This not only helps payers understand, compare, and benchmark this data, but also helps reward providers for excellent care. Improving patient outcomes is and should always be the primary goal of healthcare. By leveraging smart technology and advancing OBC within specialty areas, we can make significant strides in restructuring the system to meet a higher standard of care.

Linda Leigh Brock, Vice President of Product Management at NASCO
Healthcare organizations frequently attempt to manage complex VBC contracts—which focus on population health, longitudinal outcomes, and total cost of care (TCOC)—using their existing IT stack that was purpose-built and optimized exclusively for fee-for-service (FFS). Forcing VBC metrics through a claim-driven FFS engine produces slow, inaccurate, and retrospective data, which undermines effective risk management and limits the shared potential of payers and providers. To overcome FFS stack failure, health systems must invest in a dedicated digital infrastructure designed to deeply understand the contractual models, engineer VBC performance, and automate important VBC operational requirements, including:

• Contract Ingestion, Management, and Forecasting: Providing timely and insightful financial and performance visibility against specific alternative payment model (APM) targets with continual forecasts and insights around potential shared savings or losses
• Clinical Pathway Standardization: Integrating analytical insights into the workflow to support clinical staff in maintaining common approaches to patient interventions, care delivery, and the management of pathway variation
• Risk Reconciliation: Automating the calculation of TCOC and risk exposure longitudinally, which the FFS engine cannot manage easily

AJ Patel, CEO at TeleMed2U
Healthcare IT is critical for capturing, normalizing, and reporting quality measures tied to reimbursement (e.g., HEDIS, STAR, MIPS), and yet currently data remains siloed across EHRs, claims systems, and remote monitoring platforms, and quality measure definitions continue to vary across payers, creating redundant workflows. In order to truly make an impact, the healthcare technology stack needs to fully integrate EHR data, encounter notes, and remote vitals into real-time dashboards that enable both providers and health plan partners to more effectively monitor compliance and outcomes longitudinally.

Jay Ackerman, CEO at Reveleer
Healthcare IT tools can streamline the tracking and reporting process by unifying data from multiple sources and automating the extraction of quality metrics. Advanced systems can analyze both structured and unstructured clinical data to surface key insights for quality and compliance reporting. Where it’s not happening, data remains siloed, and workflows are still manual, making it impossible to turn insights into action.

Julie Sacks, CEO at Home Centered Care Institute
Healthcare IT tools play a critical role in enabling providers to track, benchmark, and report the quality metrics and outcomes required for value-based reimbursement. While many data analytics platforms support this kind of reporting, we’re seeing growing interest in custom data projects—those that allow practices to integrate their own patient or member data with external market intelligence. This dual lens helps providers monitor internal performance (e.g., quality and cost benchmarks within their practice or ACO) while also evaluating how they compare across broader geographies—locally, regionally, or nationally.

Where this isn’t happening (and should be) is among smaller or home-based practices that often lack the resources or infrastructure to build or access these tools. Helping these providers build the capacity to track outcomes and identify areas for improvement ahead of CMS reporting cycles is essential for equitable participation in value-based care.

Ed Hoffman, SVP, Head of Mobility at Modivcare
As we shift toward value-based care, one of the most powerful tools we have is the ability to turn data into actionable insight. By building interoperable systems that connect EHRs, health plans, and member apps with non-emergency medical transportation (NEMT) platforms, we can close a major gap in care: access.

When providers and plans have visibility into transportation barriers, they can intervene earlier—rescheduling missed rides, reducing delays, and helping members reach critical appointments. This connected infrastructure not only improves service delivery—it helps us prevent avoidable health episodes before they escalate.

Ahzam Afzal, Co-Founder and CEO at Puzzle Healthcare
Amid both Medicare and Medicaid cuts and implications from the government shutdown, value-based care programs are more critical for providers than ever before. Not only do providers need to protect cash flows during a time of economic uncertainty, but they also need to instill trust in the patients seeking care by keeping the lifetime of care in mind. For hospitals and health systems, fee-for-service margins are breaking down, and many are left facing major payment delays. Value-based care programs offer these health systems a new path forward by providing them with opportunities to expand revenue streams.

Through value-based care models paying providers to prevent hospitalizations and readmissions, health systems are increasingly moving high-need populations into ACOs, full- or partial-risk MA arrangements, and advanced primary care models, enabling much closer monitoring during crucial 90-day care windows. This shift takes healthcare organizations away from visit-based thinking and allows them to focus on the lifetime of a patient’s care – ensuring both continuity of care and the longevity of a patient’s wellbeing.

By embedding these value-based care initiatives into daily operations, health systems not only better position themselves to deliver more predictable, patient-centric care, but they also work to protect their revenue despite ongoing financial and operational uncertainty.

Frank Vega, CEO at The Efficiency Group
The right IT tools automate metric capture inside the workflow, so reporting becomes a natural output of care and not an administrative burden. Too many providers still rely on manual spreadsheets and disconnected systems, especially in community care and rural settings, where automation could have the biggest impact.

Mary Sirois, Senior Vice President, Strategic Solutions at Nordic
Healthcare IT tools have enormous potential to help providers track and report quality metrics for VBC reimbursements, but you won’t get credible, enterprise-wide quality reporting until you simplify and standardize the technology estate and have a disciplined data governance structure in place. Nowhere is this a bigger issue than in post-M&A health systems where duplicative tech-stacks result in cumbersome workflows, inconsistent measure logic, lack of enterprise data governance, the need for interoperability, and risk of cybersecurity incidents.

Systems that delay integration, instead of running two of everything for years post-deal, end up with irreconcilable data and reporting that does not enable a high-performing care organization with the knowledge and ability to effectively manage risks and costs for their VBC contracts and the patients covered by such.

In these situations, interoperability, integration, and platform rationalization are prerequisites to trustworthy metrics and attestations. Merged health systems must align on one backbone (EHR, rev cycle, digital health, analytics, ancillary systems, ERP), retire duplicative apps quickly, and invest in governance so definitions match across service lines and the continuum of care.

Shitang Patel, VP, Payers at CitiusTech
Healthcare IT tools should serve as the connective tissue of value-based care, consolidating quality metrics, utilization/ACO measures, evidence-based guidelines, and patient-reported outcomes into an integrated, patient-centered view. Further, most organizations operate a series of isolated reporting stacks – one for HEDIS, another for STARS, one for risk adjustment, another for readmissions, etc. This lack of an ‘integrated data layer’ forces providers into manual reconciliation, duplicative workflows, and a reactive approach to managing performance.

Where this is not happening is clear: virtually every program operates in a silo. Providers are burdened with overlapping dashboards and inconsistent quality definitions from CMS and private payers. The absence of a unified platform means that even when tools exist, they fail to guide decisions or improve health outcomes. To enable real VBC, IT systems and data platforms must be able to collect and disseminate data seamlessly (interoperability), create and maintain a longitudinal understanding of patients, and enable a personalized digital experience for patients and clinicians alike.

Susan Lofton, MPT, VP, Outcomes and Clinical Transformation at WebPT
Effective Health IT tools can enable providers in three key areas: capture quality data at the point of care without adding burden, automatically calculate measures against multiple frameworks (MIPS, ACO, payer-specific), and generate reports that satisfy various business needs + regulatory requirements. The best systems make quality measurement invisible to clinicians.

Where this isn’t happening: Small to mid-size practices, especially in outpatient therapy, primary care, and specialty practices. These settings often lack the resources for sophisticated analytics, and as such, they are often stuck with basic EMRs that track volume, not value.

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 do you think healthcare IT tools can enable providers to track and report quality metrics and outcomes required for value-based care reimbursement? Where do you see this not happening, but it should be? Let us know over on social media, we’d love to hear from all of you!