Value-based care ties provider and plan reimbursement to patient outcomes and quality performance rather than service volume, per CMS. This shows up concretely in HEDIS measures and CMS Star Ratings, a 1-to-5 scale where a plan scoring 4 stars or higher qualifies for CMS quality bonus payments.
90% of users from payors who have implemented the OnMed CareStation® have no primary care provider, meaning they are effectively invisible to a plan's existing value-based programs until an access point reaches them. Reaching that population moves both sides of the value-based equation, but through two different mechanisms. On the quality side, catching chronic conditions earlier and reducing avoidable ED utilization directly moves the HEDIS and CAHPS measures that feed into Star Ratings—the same 4-star threshold that determines quality bonus eligibility. On the MLR side, the mechanism isn't utilization reduction itself; a plan already well above its 80%/85% floor gains more from cutting excess claims cost than one sitting close to the floor. It's classification: 36% of CareStation cost qualifies as QIA/MLR-positive spend, giving a plan a way to invest in access without that spend counting against the administrative ceiling it's managing to. See: MLR.
Fee-for-service reimburses based on the volume of services delivered. Value-based care ties reimbursement to patient outcomes and quality performance instead, per CMS.
90% of CareStation users in the Payor vertical have no primary care provider (the general figure is 80%; 90% is the payor-specific figure per OnMed's Payor Placemat), meaning they're largely invisible to a plan's existing quality programs until an access point reaches them and begins generating chronic-condition detection data at scale. The CareStation lowers traditional barriers to care by placing healthcare in convenient community locations, which makes it easier for hard-to-reach members to engage and creates more opportunities for preventive care, follow-up care, and chronic condition management.
Every term here points to the same gap in healthcare access. See how the CareStation closes it.
Talk to Our Team
