Automation enables the promise of value-based care

Value-based care has long promised a healthcare system that delivers better outcomes, improves the patient experience, and reduces costs. Yet, despite years of advocacy and incremental progress, many health systems still find themselves navigating the complexities of switching from fee-for-service models, handling manual administrative work, and trying to connect fragmented patient engagement. By failing to successfully transition, they’re missing out on potential billions in enterprise value.

The vision of a value-based care future is clear, but the execution has remained elusive. 

However, a solution is becoming more mainstream in the healthcare industry: automation.

Bridging the gap between intention and impact 

A smooth and effective transition to value-based care requires precision in managing patient populations, timely engagement, accurate documentation, and seamless coordination across diverse teams and systems. For most organizations, these expectations can’t be met through human effort alone. 

Automation supports the shift from volume-based to value-based care by making it practical and scalable to monitor, manage, and improve patient health consistently and efficiently. It does so by transforming labor-intensive, manual processes into intelligent, repeatable workflows that enable providers to focus on delivering high-quality care rather than managing administrative burdens.

Reimagining patient engagement and access

Proactive intervention lies at the heart of value-based care. Yet many health systems still rely on reactive, impersonal communication methods that result in missed appointments, open care gaps, and fragmented relationships with patients. 

Automation changes this dynamic. 

Take care gap outreach, for example. With AI-powered Agents, health systems can automatically identify patients overdue for screenings, labs, or chronic care management, and reach out via SMS, phone, or other preferred communication methods with personalized instructions and self-scheduling options. This results in higher rates of preventative care visits, fewer complications, and improved quality scores. 

Through automation, Montage Health has reached a 14.6% care gap closure rate, reviewing over 17,000 charts to date and resulting in over 100 patients at risk for HPV sent for follow-up care. Castell, Intermountain’s population health company, automated care gap closure across all 468 of its providers and saw a 6.9% increase in average closure rate after reviewing and uploading over 100,000 charts for payer care gap attestation.

Additionally, automated appointment scheduling and PCP matching make it easier for patients to access the right care at the right time, supporting continuity and trust. These are all central goals of value-based care models. 

Enabling consistency in quality and documentation

Accurate, real-time documentation isn’t just a billing necessity; it’s a foundation of value-based care. Risk adjustment, HEDIS metrics, STAR ratings, and shared savings all depend on complete and correct clinical data. 

AI Agents can handle documentation and coding with greater speed and accuracy than human staff, surfacing relevant information from structured and unstructured data in EHRs, transcribing visit summaries, and ensuring diagnoses and procedures are accurately captured. This reduces the downstream rework caused by errors and improves compliance with quality reporting standards. 

And because AI Agents never sleep, the work gets done faster, reducing delays in billing, reporting, and care coordination.

Security Health Plan and Marshfield Clinic Health System captured over 2,800 additional conditions annually with automated HCC coding, resulting in a 6.4% accuracy rate and over $7M of additional annual revenue.

Scaling care coordination without adding headcount

Transitioning from reactive to proactive care requires ongoing communication with patients after their visits, often referred to as care coordination. This includes transitions of care, medication adherence outreach, chronic condition monitoring, and more. But few organizations have the clinical staff capacity to engage every patient at the frequency needed.

Intelligent automation bridges that gap, with AI Agents able to act as care coordinators to assess patient needs, send reminders for medication refills or follow-up visits, and escalate to human staff when needed. 

By automating the routine tasks, nurses, care managers, and physicians can focus their expertise where it makes the biggest impact. MUSC Health was able to allocate over 1,300 hours per week of caregiver time to higher-value patient care tasks after augmenting its workforce with automation. Castell saved 8,360 hours of staff time over just two weeks by automating payer care gap attestation.

Driving down costs while maintaining quality

At its core, value-based care aligns financial incentives with better patient outcomes. But to truly lower costs while improving care, health systems must eliminate the inefficiencies that drive waste, like unnecessary tests, duplicate referrals, and delays in care delivery. 

With an AI platform, health systems can streamline operations across departments, resulting in outcomes like: 

• Reducing prior authorization turnaround times by up to 80%
• Reducing revenue leakage by 83% with real-time referral processing 
• Lowering contact center volumes and boosting patient satisfaction with self-service patient billing and scheduling capabilities 
  

By connecting workflows across an integrated platform, health systems can see millions of dollars in annual savings, improved workforce productivity, and satisfied patients who continue to return to a seamless, efficient, and personalized healthcare experience.

From vision to reality

Ultimately, automation enables the shift to value-based care by making it practical and scalable to monitor, manage, and improve patient health. By digitizing workflows that once required hours of manual effort, healthcare organizations can meet the demands of value-based care without overextending their teams. 

To deliver on the promise of value-based care—better outcomes, lower costs, and improved experiences—systems need more than vision. They need capability. With intelligent automation, that is now within reach.