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Accelerating into the Future: AI's Impressive Influx in Value-Based Care

In a recent collaboration, Reveleer, a pivotal technology platform in value-based care, and Mathematica, a policy data analytics firm, unveiled their 2026 State of Technology in Value-Based Care report. This critical document illustrates a significant shift in the healthcare landscape, revealing that while the adoption of artificial intelligence (AI) and contemporary technologies by payers and providers has rapidly advanced, the corresponding operational readiness and governance remain unprepared.

The 'Prove-It' Phase of Value-Based Care

According to the report, value-based care (VBC) is entering a pivotal phase characterized by the necessity to validate technology's efficacy and implementation. Jay Ackerman, CEO of Reveleer, emphasizes the transition in the healthcare discourse. He notes, "The debate over whether healthcare organizations should adopt AI has ended. The challenge now is accountability." While organizations have embraced AI to enhance decision-making processes involving reimbursement and compliance, the need for transparency and documentation of these decisions has never been more pressing.

As regulatory expectations grow, organizations that wish to excel will need to embed a culture of accountability and verifiable data across all workflows. The report indicates that regulators focus on tangible records and authentic clinical data rather than intentions. Consequently, the need for a precise documentation process that tracks data back to trusted clinical evidence is growing.

Survey Insights: Bridging the Accountability Gap

The findings of this report are based on a national survey conducted by The Harris Poll, involving 200 senior decision-makers from VBC organizations. The analysis brought to light a widening gap in accountability across VBC operations. Organizations are incorporating more technologies than ever, yet many still depend on manual workflows. Nearly 94% of providers still utilize manual processes within their VBC workflows. Moreover, only 35% of these organizations have clearly documented procedures to address erroneous AI outputs, substantiating the claim that the rapid adoption of AI far exceeds the necessary operational governance and discipline.

The Confidence Conundrum

As organizations rush to adopt technology, confidence in data quality has emerged as a considerable constraint. The survey indicates that 93% of providers and 88% of payers harbor fears regarding AI discrepancies or 'hallucinations', which significantly impede its broader adoption. Consequently, reliance on external AI vendors has grown, with 68% of payers and 74% of providers depending on these third-party entities, yet an overwhelming 93% of organizations believe these vendors have overhyped their capability to enhance VBC performance.

Ngan MacDonald, Director of Data Innovations at Mathematica, highlights the critical juncture healthcare organizations have reached. She states, "Success will depend on how well organizations exploit technology," recognizing that technology can catalyze progress but cannot substitute for an understanding of organizational operations. Effective governance, documented workflows, and trustworthy data are essential for organizations to automate confidently and extract operational value from these technologies.

Regulatory Pressures and the Need for Robustness

Amid rising regulatory scrutiny, organizations face added challenges to ensure documentation, data accuracy, and accountability in light of initiatives such as Medicare Advantage Risk Adjustment Data Validation audits. Alarmingly, only 13% of payers and 29% of providers feel adequately prepared for current Centers for Medicare & Medicaid Services (CMS) requirements. As regulatory expectations intensify, VBC necessitates the capability to trace, validate, and support technology outputs with verifiable clinical evidence that adheres to regulatory standards.

Navigating the Path Ahead

The full report outlines five emerging trends that will influence the next phases of value-based care, focusing on increased VBC contracting and growing reliance on third-party AI vendors. Organizations are at a crucial moment where technological advancement must be paralleled with escalation in governance and operational readiness to harness the full potential of their investments.

As the industry pushes forward, navigating these complexities while maintaining transparency and building trust with stakeholders will be essential for the success of value-based care initiatives. The findigs underscore that only those who bolster accountability within their frameworks will emerge successfully in this evolving landscape.

For more comprehensive insights, stakeholders can download the full report on the state of technology in value-based care. The findings set the stage for a healthcare future built around accountability and efficiency, ushering an era where AI and technology effectively enhance the healthcare ecosystem's delivery, quality, and compliance.