Innovation Boost: Improving Access, Outcomes, and Efficiency in Healthcare

As health systems look for care-delivery innovations that provide value at both system and patient levels, health economics and outcomes research (HEOR) principles are informing their strategies.

By Beth Fand Incollingo

With so many advances emerging across the pharmaceutical and medical device arenas, stakeholders might expect corresponding improvements in health outcomes, along with some financial efficiencies. But in many cases, those results never materialize because their benefits are offset by complex and cumbersome models for healthcare delivery.

That’s why experts in health economics and outcomes research (HEOR) are working to support innovations that can reshape the way healthcare is provided. In small private health systems and larger national ones, these approaches are being leveraged to improve patient and physician experiences while getting the most out of every payer dollar.

“I believe that the interplay between HEOR researchers and health systems is an important one to continue to nurture,” said Michael Simonov, MD, Chief Product Officer at Truveta, a healthcare data and artificial intelligence (AI) company. “It’s important for health systems to understand whether they’re choosing therapies that are beneficial both clinically and from an economic standpoint.”

Health systems might innovate by heightening their emphasis on prevention, introducing technology to manage healthcare populations, or changing the setting of care. Many such approaches align not only with ISPOR’s Science Strategy and translation-to-practice agenda but also with the Top 10 HEOR Trends it has identified for 2026 and 2027, which include real-world evidence (#2), value-based healthcare (#3), artificial intelligence (#1), patient-centricity (#6), and digital health (#10).

As a nonprofit, integrated organization in the United States, Kaiser Permanente has joined countries like Singapore in demonstrating the innovations that can arise out of value-based care—a model encouraged by ISPOR in a July 2026 task force report that introduced a new framework for applying HEOR tools to value-based healthcare implementation.

In value-based systems, doctors are paid based on the populations they treat and the health outcomes they generate. Compared with fee-for-service care, this removes incentives for unnecessary treatment, encourages commitment to prevention, and promotes health system effectiveness and sustainability.

“Every dollar invested in preventing a hip fracture can save patients significant pain and disability while potentially reducing treatment costs twenty-fold or more and produces better economic and health outcomes,” said Tad Funahashi, MD, an Orthopedic Surgeon and the Chief Innovation Officer, Emeritus, for Kaiser Permanente Southern California (KPSC).

Kaiser Permanente is also innovating by collaborating system-wide to collect, analyze, and share real-world data (RWD) about outcomes, resource use, and costs—data that allow member practitioners and facilities to learn from their own performances and those of their peers. The health system also uses that pipeline to maintain a registry of implanted medical devices, such as artificial knee joints, and outcomes associated with the implantations. This database provides insights that can guide practitioners in reducing revision and readmission rates, Funahashi said.

“There’s a profound complexity to how healthcare systems can provide the best possible care, so there’s a deep need to innovate and learn together about which treatments are the most impactful.”— Michael Simonov, MD

“We can even do comparative analysis at the case level, giving reporting on revision, reoperation, and infection rates,” he said. “If there is an outlier, they can try to figure out why and make changes that improve their results—for instance, by choosing specific artificial joints that are associated with better clinical outcomes.”

Truveta is another organization that uses continuously updated, de-identified RWD to provide health delivery insights, but the company serves a broader array of stakeholders—the 30 US healthcare system members that govern it, as well as a host of outside subscribers, from governments to drug developers. It describes AI as central to the way it collects, aggregates, synthesizes, and compares the information its members gather from electronic health records, clinical notes, medical images, and insurance claims.

Truveta supports the ability of health systems to learn from their own performances by enabling its partners to quickly transform RWD into evidence about comparative treatment effectiveness, safety, clinical research, health disparities, care quality, and population health, Simonov said.

“There’s a profound complexity to how healthcare systems can provide the best possible care, so there’s a deep need to innovate and learn together about which treatments are the most impactful,” he said. “That kind of learning needs to be democratized beyond the 4 walls of a health system, and the emergence of AI is opening the door for how that can happen at a national and international scale.”

Exploring Value-Based Care

Innovations are needed because health systems around the world are looking for ways to reduce the stress placed on their limited resources by an aging population with growing medical needs.

In America, a lack of universal access is also challenging the effectiveness of the healthcare system, Funahashi said. While healthcare comprises 18% of the US gross domestic product, a far higher percentage than in other high-income countries, America’s system generates poorer health outcomes than its peers. To make matters worse, he said, rising utilization rates are increasing financial pressure on Medicare, the public health-coverage program for older Americans.

“For the people who have commercial insurance and all the access they need, I do believe America still offers the most state-of-the-art healthcare you can get in the world,” Funahashi said. “But there are many people who don’t have access or can only access healthcare in less-than-ideal ways, and because of that, the overarching population is not doing that well.”

One response to those issues is value-based care, which is in the early stages of adoption around the world, according to a 2025 literature review. Among the countries testing the strategy is the Netherlands, where the idea is considered a national health-policy priority and has been incorporated by numerous hospitals. Over a decade, one pioneering hospital there has incorporated value-based care by blending deep changes to specific local practices with larger-scale, hospital-wide policy updates.

Singapore has been shifting toward value-based care because of its “super-aged” society, where 21% of people are now aged 65 years or older. Between 2017 and 2023, across 19 medical and surgical conditions, the country’s value-based innovations were associated with the saving of 320 additional lives, the avoidance of 1753 repeat surgeries, the prevention of 589 hospital readmissions, and 22,000 fewer hospital bed days.

Value-based care is utilized within numerous health systems in the United States, too, where Medicare runs a Shared Savings Program that allows providers to form accountable care organizations and, through another initiative, provides bundled payments to practitioners for treating entire medical episodes, such as all the services involved in a joint replacement.

“Every dollar invested in preventing a hip fracture can save patients significant pain and disability while potentially reducing treatment costs twenty-fold or more and produces better economic and health outcomes.”—Tad Funahashi, MD

Kaiser Permanente’s model groups a single payer and all its member facilities and doctors under 1 cooperative umbrella, with the goal of optimizing the value of every dollar spent. The model’s ability to compile and analyze large amounts of RWD has led to several innovations that boost convenience and conserve resources by reducing on-site patient visits—including a project that has streamlined the diagnostic process for certain acute disease states. One study used electronic health records data to establish processes that have abbreviated how long it takes for patients with metastatic non-small cell lung cancer to receive pathology reports describing the molecular characteristics of their disease.

“What is the improvement in cost if we can cut diagnostic time from 6 weeks to 2 weeks by reducing the number of appointments and tests a patient needs?” Funahashi asked. “It’s such a rich field of study that we need to be doing in the United States to demonstrate how to improve the economics of healthcare.”

Through Risant Health, a company it created, Kaiser is working to spread value-based care throughout the United States. Risant’s nonprofit, value-based health systems include Geisinger, headquartered in Pennsylvania, and Cone Health, based in North Carolina.

Transforming Primary Care

Health systems around the world are also finding other innovative ways to target unmet medical needs, among them a reimagining of primary care provision.

In 2025, the director of the Pan American Health Organization called for the redesigning of primary care to close gaps in the management of noncommunicable diseases and mental health issues.

According to an Organisation for Economic Co-operation and Development (OECD) report, Brazil had already been working to meet that challenge through its Sistema Único de Saúde, or “unified health system,” which introduced free, local preventive and primary care provided by multidisciplinary teams. Funded federally but organized by municipal governments, this system shifted care away from urban hospitals with the goal of supporting health equity by more broadly reaching underserved populations. Since its origins in 1990, the program’s expansion has led to significant improvements in infant mortality rates, maternal health, vaccine uptake, hospitalization incidence for chronic conditions, and life expectancy.

Most recently, Brazil adopted a policy designed to integrate its healthcare services, with primary care as its axis.

Meanwhile, healthcare leaders in Chile are using digital technology at a population level to expand the primary care net. Working with clinics, experts from the Universidad de Valparaíso are using the technology to engage patients who frequently miss appointments.

So far, the program, known as SISTAM, is helping about 100 public primary care centers use data they already have to identify and contact patients who have been lost to follow-up, said Keiko Sahori Veintimilla Carrión, a biomedical engineer and health sciences doctoral student who is part of the university team developing the program. SISTAM, which uses AI but also simpler technologies when those are more cost-effective, identifies regions where missed appointments are common, determines which patients live in those areas, and works to improve engagement by sending personalized digital reminders to their phones.

“If we see that many people from the same area are not attending their appointments, we can ask if there are problems with transportation, distance, or other social factors,” Veintimilla Carrión said. “With SISTAM, teams can consider information like age, health conditions, and use of services, and that can help them see the situation in a broader way.”

In 2023, SISTAM announced the 6-month results of its use at the family health center of Dr Carlos Godoy in Maipú, which included a 91% increase in attendance at health outreach events and a 14% reduction in missed appointments for health issues including electrocardiograms, during a month when patients received phone and text reminders about their appointments.

And in a pilot program from March through June 2026, SISTAM helped increase vaccine uptake by sending digital messages to target populations within 3 towns. Vaccination rates for influenza, COVID-19, and respiratory syncytial virus increased by 8.1 percentage points in El Quisco and 3.42 percentage points in Padre Hurtado, although they did not improve uptake in Curacaví, where only about half of eligible patients were reachable electronically.

“With SISTAM, teams can consider information like age, health conditions, and use of services, and that can help them see the situation in a broader way.”— Keiko Sahori Veintimilla Carrión

“The context of each community is very different,” Veintimilla Carrión said, “so the type of messages we send or the number of reminders may need to change.”

SISTAM leaders also support a more person-centered model of care.

“The idea is to stay connected with people over time, not just when they are sick or when they have an appointment,” she said. “We want them to have more information, take a more active role in their health, and feel supported by their health centers.”

Shifting the Setting of Care

Another key theme driving health-system innovation involves shifting the setting of care.

Care administered near or at patients’ homes is encouraged by the National Health Service in England, which, along with Israel, has demonstrated that the hospital-at-home model can be up to 50% less costly than inpatient stays. Across the members of the Organisation for Economic Co-operation and Development, at least 22 countries offer hospital-at-home programs, including Australia, Canada, Chile, France, Japan, Mexico, Switzerland, and Spain.

At KPSC, Funahashi said, a hospital-at-home program treats 100 patients a day.

“For many patients, the reason they need to be in the hospital is because multiple teams need to closely monitor their symptomology until we can make them better,” he said. “Interestingly, if we really leverage technology, we can take many of those measurements in the patient’s home, where patients are probably more comfortable.”

In a 2026 study, KPSC demonstrated that patients with heart failure had comparable levels of readmissions, mortality, and days alive and out of the hospital when treated at home versus in a Kaiser Permanente facility.

KPSC has also moved cardiac rehabilitation out of its facilities and into patients’ homes by using smart watches to connect them with nurse practitioners. By easing barriers such as a lack of transportation, childcare, or free time, the program has significantly increased the percentage of eligible patients who participate, reduced hospital readmission rates, and equalized health outcomes across ethnicities and genders.

Now the concept should serve as a model for healthcare systems everywhere, Funahashi said.

“If cardiac rehabilitation was a drug, it would be a blockbuster because of how dramatically it improves health outcomes. Yet, in the United States, most eligible patients never get it,” he said. “We would like to see government agencies and academic centers doing refined health economics analysis on this to demonstrate its beneficial impact.”

Incorporating Technology

AI is becoming increasingly central to innovation across every aspect of healthcare, and that includes changes to the way systems deliver services.

A report by the World Health Organization in April 2026 showed that 74% of the 27 members of the European Union use AI-assisted diagnostics and 63% employ chatbots to engage with patients. Currently, the region is adding workforce training to ensure that AI will continue to support safety, equity, and accountability in healthcare.

“Increasingly, AI is landing in virtually every workstream within a health system. It’s appearing at the bedside, where clinicians use AI for decision support, in revenue cycle management, and in quality improvement,” said Simonov, who practices medicine within the US Department of Veterans Affairs.

The KPSC Innovation Studio uses HEOR principles to solve problems, choosing only projects that are expected to impact numerous lives, have feasible and scalable solutions, and generate outcomes that add measurable value.

At Kaiser Permanente, leaders have tasked ambient AI with listening during patient visits and creating most of the necessary written notes, so that doctors don’t have to do it afterward.

“As wonderful a gift as the electronic medical record is in terms of the comprehensiveness of the notes,” Funahashi said, “it has also turned us into file clerks and stenographers, so ambient AI is a huge burden saver.”

Truveta deploys AI to look for patterns and trends in RWD that shed light on issues such as which treatments are associated with the best outcomes, how to reduce emergency-room waiting time, and whether revenue generation is meeting expectations.

“If you want to study whether patients with access to transportation do better or worse on a therapy, it’s typically hard to get that information, because it’s often only documented in a clinical note or in the deep bowels of the electronic health record,” Simonov said. “Getting it out, cleaning it, and making it usable for research with AI is important to understanding all the facets of patient care.”

Truveta’s database is among a growing group of large-scale platforms that aggregate data generated by millions of patients, and the company also uses it to support research into public health issues—not only on behalf of members, but for subscribers including pharmaceutical companies, life sciences firms, government agencies, and academic and research institutions.

That work has helped identify patients who were eligible for clinical trials and explored issues ranging from GLP-1 prescription patterns to uptake of vitamin K for newborns to oncology drug use. Now, Truveta plans to use AI to delve more deeply into the human genome, potentially helping to pave the way for the development of new treatments for rare diseases.

And soon, it expects to offer an additional service.

“We’re investing in proactive intelligence, a set of capabilities where customers can learn about things they didn’t ask for,” Simonov said. “We can leverage our AI engines to identify signals that our members and clients should consider, because they could suggest a meaningful impact and, potentially, opportunities to improve patient care or outcomes.”

Relying on HEOR

So, how are HEOR experts contributing to these health system innovations?

The multidisciplinary team in the KPSC Innovation Studio that Funahashi oversees uses HEOR principles to solve problems, choosing only projects that are expected to impact numerous lives, have feasible and scalable solutions, and generate outcomes that add measurable value.

“We’re actually measuring outcomes beyond whether a project saves lives, reduces readmissions, or improves quality, services, or costs in any way,” he said. “We’re also measuring the unintended consequences, because sometimes when you come up with a great solution for 1 problem, it creates a different problem for somebody else.”

With AI-driven innovations, it’s also important to keep humans in the loop to deploy technology in a way that keeps an organization’s ideals and desired outcomes at the forefront, Simonov said.

HEOR professionals can guide that process by “demanding that the systems we use are scientifically rigorous and founded in rational and scientific thought,” he said. “There are infinite questions that need to be weighed methodologically, and as a community, that’s something we should all be invested in.”

Finally, Simonov said, continuing to gather RWD and use it for HEOR will be essential for filling gaps in the literature about conditions like rare diseases.

“The answers AI gives will only be as good as the publications that are out there,” he said, “so being able to capture that human experience and bring it to these learning systems is absolutely crucial to delivering exceptional and personalized care.”