U.S. Value-Based Healthcare Service Market Size, Share, By Models, Deployment Mode, and End Use - Trends, Analysis, and Forecast till 2035

• U.S. value-based healthcare service market size is projected to grow at USD 7.8 trillion in 2035.
• The target market was valued at USD 4.02 trillion in 2024.
• The market is growing at a CAGR of 7.5%.

Value-based healthcare is a healthcare delivery model where providers are paid based on patient health outcomes, rather than the amount of services they provide. Target market is driven by the rising pressure on the health system due to the constant increase in healthcare spending, increasing prevalence of chronic illnesses, and enhanced government initiatives. In addition, a rising demand for more cohesive care delivery systems, and increasing focus on population health management in the region are another factors propelling the market growth. Furthermore, its widespread usage in variety of industries such food & beverages, personal care, and cosmetics, rising disposable income, growing population, and others.

Key Takeaways:

According to the article published by PwC, over the last 10 years, most U.S. payers and providers have implemented some form of Population Health Management (PHM) to address problems that contribute to poor health conditions in populations and communities.

Key Drivers of Target Market:

Increasing Cases of Chronic Diseases to Drive the Market Growth

Rising cases of chronic diseases helps to drive U.S. value-based healthcare service market growth as managing a chronic disease or condition such as cancer, diabetes, high blood pressure, COPD, or obesity can be costly and time-consuming for patients. Value-based care models focus on helping patients recover from illnesses and injuries more quickly and avoid chronic disease in the first place. 

• For instance, according to the data published by Centers for Disease Control & Prevention in February 2024, an estimated 129 million people in the U.S. have at least 1 major chronic disease, including heart disease, cancer, diabetes, obesity, and hypertension. Five of the top 10 leading causes of death in the U.S. are strongly associated with, preventable and treatable chronic diseases. Besides the personal impact, chronic disease has a substantial effect on the U.S. health care system. About 90% of the annual USD 4.1 trillion health care expenditure is attributed to managing and treating chronic diseases and mental health conditions.

Restraints:

Data & Technology Challenges May Hinder the Growth of the Market

Effective value-based care relies on robust data collection, analysis, and sharing. The adoption and integration of health information technology systems and interoperability among different systems can be challenging and costly. 

• Counterbalance Statements: Implementing Health Information Exchanges (HIEs) and adopting Interoperable Standards, such as HL7 FHIR (Fast Healthcare Interoperability Resources) can help enable smooth data flow between different systems.

Opportunities:

Technological & Operational Adaptations Will Propels Market Growth in Upcoming Years

Transitioning to Value Based Healthcare Service (VBC) requires significant changes in how practices are run and how care is delivered. Some organizations proactively adopt enhanced electronic healthcare records (EHRs) systems explicitly designed for VBC models. Furthermore, advance technologies, such as telehealth platforms or other patient engagement tools, AI and data analytics, and among others use in VBC.

• For instance, in October 2024, the AI Centre for Value-Based Healthcare has partnered with Guy’s and St Thomas’ NHS Foundation Trust and radiology AI platform developer deep to accelerate the adoption and deployment of radiology AI in the NHS.

The U.S. value-based healthcare service market is classified into models, deployment mode, end-user, and country.

Models

Based on the models, the U.S. value-based healthcare service market is categorized into accountable care organization, patient-centered medical home, pay for reference, bundles payments, and others. The accountable care organization dominates the target market as it focuses on coordinating care for entire populations & improving overall health outcomes.

• For instance, in November 2024, NextGen Healthcare, a leading provider of innovative, cloud-based healthcare technology solutions, announced that its clients participating in the Medicare Shared Savings Program (MSSP) leveraged its NextGen Population Health solution to achieve a cumulative USD 102 million in total Medicare savings last year. The MSSP incentivizes hospitals, physician associations, and other healthcare facilities to form accountable care organizations (ACOs) that promote cost efficiency and enhance care coordination for Medicare beneficiaries.

Deployment Mode

The U.S. Value-Based Healthcare Service Market by deployment mode is categorized into cloud and on-premises. The cloud-based deployment mode are expected to dominate the target market due to their scalability, flexibility, cost-effectiveness, data accessibility, data management, and others. 

• For instance, in December 2024, Nashville General Hospital (NGH) has implemented Oracle Health CommunityWorks to unify its clinical operations across its 150-bed hospital and 20+ outpatient facilities. The cloud-based system replaces multiple legacy systems, enabling automated processes and integrated electronic health records (EHR) for improved clinical, financial, and operational efficiency.

End-Use

The targeted market, by end-use, is classified into providers, and payers. However, providers held the largest share of the market due high demand

U.S. Value-Based Healthcare Service Market Report Scope:

Segmentation:

By Models:

• Accountable Care Organization
• Patient-Centered Medical Home
• Pay for Reference
• Bundled Payments
• Others

By Deployment Mode:

• Cloud
• On-Premises

By End Use:

• Providers
  • Home Health Care
  • Institutional Care
  • Self-Care
  • Others
• Payers
  • Medicare
  • Medicaid
  • Commercial
  • Others

The key players operating in the U.S. Value-Based Healthcare Service Market include Baker Tilly Advisory Group, LP, Boston Consulting Group, Athenahealth, and among others. The key players are adopting strategies for the growth of the market such as huge distribution network, strong brand reputation, key strategies, significant marketing, and fundamental investments.

List of Key Players in the Market:

• Baker Tilly Advisory Group, LP
• Boston Consulting Group
• Athenahealth
• UnitedHealth Group
• NXGN Management, LLC
• MCKESSON CORPORATION
• Unlimited Technology Systems, LLC
• Curation Health
• Humana
• The Commonwealth Fund
• Stellar Health
• Privia Health
• Aetna Inc.
• ForeSee Medical, Inc.
• Kaiser Permanente
• Signify Health, Inc.

• In October 2024, California Gov. Gavin Newsom recently signed legislation that extends a pilot program enabling California’s school districts to partner directly with medical groups to purchase healthcare for their workforce. The pilot, an agreement between California Schools Voluntary Employees Benefits Association  (VEBA) and members of America’s Physician Groups (APG), aims to introduce a value-based payment model designed to reduce overall healthcare costs while improving the quality of patient outcomes. 
• In July 2024, Innovaccer Inc., a leading healthcare AI company, announced a new strategic partnership with P3 Health Partners, a patient-centered, physician-led population health management company revolutionizing care delivery for Medicare patients. This partnership marks a significant milestone in advancing value-based care initiatives aimed at improving patient outcomes, optimizing costs, and enhancing the patient and clinician experience.
• In April 2024, Arbital Health, a technology company focused on accelerating the healthcare industry's transition to value-based care, announced the debut release of its platform for value-based contract adjudication. Arbital Health's platform facilitates secure data sharing and contract adjudication among Employers, Payors, Point Solution Vendors, Providers, and Accountable Care Organizations that serve members within a value-based care arrangement.
• In June 2021, Curation Health, a leader in advanced clinical decision support and value-based care (VBC) adoption, announced significant 2021 momentum in customer acquisition and expanded additions to its already robust suite of services. The new services build on the company’s existing platform, physician education, and advisory offerings and will further help providers and health plans more effectively collaborate in value-based agreements.

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