Payers and Providers Align on Value-Based Care Tech But Struggle to Deliver It

A new report released today from Mathematica and Reveleer, The Tipping Point: The State of Technology in Value-Based Care 2025, shows that although healthcare leaders across payer and provider organizations align on the goals of value-based care and feel optimistic about technology’s potential, critical execution gaps could stall progress in reducing costs and improving outcomes.

“Leaders agree on the direction of value-based care, and they’re making similar investments to get there,” said Ngan MacDonald, director of data innovation at Mathematica. “But alignment alone isn’t enough. What’s needed now is strategic and responsible technology adoption. The window for transformation is wide open, offering leaders a unique opportunity to shape the future of care delivery.”

Value-based care prioritizes high-quality care, improved patient outcomes, and reduced costs, making it a compelling alternative to traditional fee-for-service models. Based on a survey conducted by The Harris Poll of more than 200 directors, executives, and C-suite healthcare leaders, the report reveals that most organizations expect their value-based care contracts to grow in the coming year and plan to invest more in data management and artificial intelligence (AI). But their success will depend on getting the technology and the data right to build the foundation needed to execute at scale. 

Federal policy is also raising the stakes for transformation. As the Centers for Medicare & Medicaid Services commits to more technology-forward and patient-centric models, and the number of traditional Medicare beneficiaries in accountable care relationships continues to rise, the urgency for interoperable infrastructure is high. In addition, the One Big Beautiful Bill Act provides $50 billion to support states in their transformation of rural healthcare through innovative care models and technology-enabled solutions. Successful rural health transformation will likely use the limited-time funding to identify new or reorganized service delivery structures, incentives, or technologies that reimagine rural health.

Despite investments and policy tailwinds, execution still lags. Our new report highlights two primary areas where momentum is being tested.

The value of data is clear, but persistent challenges hinder efficiency and effectiveness. Healthcare leaders unanimously agree on the importance of strong data management, but many still grapple with platform complexity, manual processes, and data integration. Concerns about data quality and data security remain top barriers to interoperability, and efforts to standardize data formats are challenged by the complexity of the data itself. Organizations also face difficulty translating confidence in their data into system-level operational use: most express confidence in the completeness and accuracy of their data, but only about one-third of leaders rate their data integration capabilities as “excellent,” seven in 10 report that existing platforms are too complex or time-consuming for providers to use effectively, and eight in 10 agree that there are too many manual processes in their value-based care workflows.

AI Is widely used but not fully trusted. All surveyed leaders are using AI, and 98 percent believe AI and advanced analytics will be essential to value-based care’s success. More than nine in 10 say AI adoption and implementation provides a competitive advantage, and most agree that AI use has a growing return on investment. They report positive impacts of AI on clinical decision making, patient outcomes, provider workload, operational efficiency, predictive modeling, and the overall costs of administering value-based care models. Yet only 40 percent of payers and 38 percent of providers say their organizations are fully committed to AI adoption, and fewer have seen significant increases in AI use. Providers and payers point to regulatory and privacy concerns, challenges with system integration, lack of staff expertise, and fear of AI hallucinations as common constraints.

“This is a defining moment for value-based care,” said Noland Joiner, vice president and chief technology officer at Mathematica. “Technology may enable value-based care, but it’s the combination of strong data governance, high-quality data, secure systems, skilled staff, and responsible AI innovation that will ultimately drive better health outcomes and lower costs. Organizations that align their goals with strategy, technology, and people now will shape the next phase of transformation.”