Value Assessment Is No Longer Just for Payers: Debating How Provider Health Systems Can Leverage HEOR Methods to Inform Decision Making Under Value-Based Care and Alternative Payment Models

ISSUE: Value-based care (VBC) ties provider reimbursement to patient outcomes, emphasizing cost efficiency, quality of care and health equity. As the Centers for Medicare & Medicaid Services aim to enroll 100% of Medicare beneficiaries and most Medicaid recipients in alternative payment models (APMs) by 2030, providers must increasingly optimize care not only for clinical outcomes but also “value”. This panel will debate the role of health economics and outcomes research (HEOR) in informing provider decision-making within APM and VBC frameworks. OVERVIEW: Dr. Jason Shafrin will moderate the panel, beginning with an overview of the VBC landscape and its intersections with health economics. Dr. Anna Flattau will provide the provider health system and clinician perspective, describing how value-based reimbursement is reshaping provider decision-making on the ground level. She will examine where HEOR methods are useful and where they may fall short in informing provider health systems. Kyi-Sin Than will explore how specific value-based payment arrangements influence provider revenue and quality metrics. She will describe how established HEOR methods can be readily adapted to align with provider priorities under VBC and share a case study example. The panelists will debate where HEOR methodologies can provide real utility to provider health systems across and how this HEOR-based analyses would (or would not) be useful across different APM structures and disease contexts, highlighting both opportunities and barriers to its adoption in provider-focused value assessments.