U.S. Value-Based Healthcare Service Market Size Report, 2023-2032
The U.S. value-based healthcare service market size was exhibited at USD 3.47 trillion in 2022 and is projected to hit around USD 7.43 trillion by 2032, growing at a CAGR of 7.5% during the forecast period 2023 to 2032.
Key Pointers:
U.S. Value-based Healthcare Service Market Report Scope
| Report Coverage | Details |
| Market Size in 2023 | USD 3.75 trillion |
| Market Size by 2032 | USD 7.43 trillion |
| Growth Rate from 2023 to 2032 | CAGR of 7.5% |
| Base Year | 2022 |
| Forecast Period | 2023 to 2032 |
| Segments Covered | Models, Payer Category |
| Country scope | U.S. |
Increased adoption of value-based care beyond primary care, increase in healthcare spending as a percentage of GDP, and continued growth in home and virtual-based models are the major growth drivers for the industry.
The Centers for Medicare & Medicaid Services' objective is to transition all Medicare providers to two-sided risk arrangements and half of its commercial and Medicaid contracts to value-based models by 2025; currently, less than 20% of Medicare expenditure is value-based. The increase of consumerism in health care, the development of new technology, the need to fulfilling the Quadruple Aim, and prioritizing preventative care while decreasing unsustainable healthcare expenditures are the primary drivers of the shift to value-based care.
Healthcare reforms in recent years have highlighted the need for electronic health information, which has raised interest in digital solutions. Furthermore, the COVID-19 pandemic has accelerated business expansion by highlighting the benefits of using electronic health information to help improve patient care and scheduling. Several countries are implementing value-based care systems. This increases the demand for high-acuity IT solutions that boost clinical efficacy and workflow, thus supporting market growth.
The rapid evolution of value-based healthcare services is one of the factors driving this market's rapid growth. Due to value-based healthcare services, the healthcare cost curve and excessive health spending have decreased. According to "UnitedHealth Group," a US-based health insurance firm that delivers value-based payments to healthcare providers, this industry's development increased by more than 16% in 2020. It supports the delivery of high-quality treatment while improving the efficient use of healthcare resources.
Furthermore, "Cigna" acquired Bright Health in December 2022, bringing additional skills and resources to continue their development toward a value-based healthcare setting. Collaborations in value-based care are becoming increasingly popular among providers because they enable partners such as medical device makers, payers, and provider groups to build programs, solutions, and initiatives that benefit both patients and healthcare systems. For instance, in June 2021, “Humana’’ acquired League, a digital health company, to create a new digital platform for Humana employer group and specialty insurance members.
To take advantage of the various types of services and technology capabilities required for future success, forward-thinking payers are broadening their options and moving beyond traditional providers. These firms have employed several techniques to improve their position in the value-based healthcare services industry in the U.S., including partnerships, collaborations, joint ventures, and mergers and acquisitions. For instance, in February 2022, Optum, a healthcare provider, completed the acquisition of Leadmark Health, a home healthcare company. It will create the first of its home-based care health system and would accelerate home health care’s move toward value-based care.
Models Insights
Pay for performance accounted for the largest market share revenue of over 29.19% in 2022 due to the rising shift from traditional fee-for-service toward payment for value-based healthcare programs. Furthermore, to reduce costs and improve healthcare for patients and society, the government has provided incentives that have driven payers to establish value-based pay-for-performance programs.
For instance, the Affordable Care Act has encouraged the Center for Medicare and Medicaid Services (CMS) to take the lead in value-based care by implementing a range of payment methods, such as several pay-for-performance programs. The Hospital Readmissions Reduction Program (HRRP), the Hospital Value-Based Purchasing Program (VBP), and the Hospital-Acquired Condition (HAC) Reduction Program are three Pay for Performance initiatives that have an impact on hospital reimbursement through Medicare. These programs accounted for nearly 40% of total spending, and CMS has established them as the primary means of financing healthcare.
On the other hand, patient-centered medical homes would register the highest market growth for value-based healthcare services during the forecast period. The ability of patient-centered medical home services to improve efficiency while providing medical assistance and reducing medical costs is one of the key factors influencing the market expansion. Additionally, this market would have significant support, as healthcare providers at both the private and public levels restructure their operations to line with value-based reimbursement and patient-centered medical home care models. For instance, Pfizer has several patient-centered medical home models with which it collaborates on care management programs (PCMH).
Payer Insights
Medicare is gradually shifting away from fee-for-service compensation toward value-based models that promote cost-cutting and quality improvement, which is anticipated to drive market growth. The Medicare Advantage (MA) program, which enables Medicare beneficiaries to voluntarily join a commercial plan that provides health benefits, was established by the Balanced Budget Act (BBA) of 1997. In a related manner, the Centers for Medicare and Medicaid Services (CMS) and private insurers have enthusiastically endorsed a number of payment strategies for primary care doctors, specialists, and health systems in taking on financial risk for the individuals they treat.
These payment plans include, for instance, bundled payments, accountable care organizations, and the comprehensive primary care initiative. All of these models have been widely embraced in both traditional Medicare and Medicare Advantage, which is predicted to fuel market expansion. Some of these models were established by CMS through the Innovation Center, while others were produced by the private sector.
Providers Utilization Category Insights
The increasing healthcare expenditure in the U.S. is a key factor driving the adoption of services for Home Health Care settings during the forecast period. For instance, as per the American Journal of Managed Care (AJMC) in 2021, there was a 19% cost decrease in home healthcare management, when comparing patients treated in a hospital environment versus those treated in a hospital-at-home setting.
Medicare reimbursements in the U.S. are extremely advantageous in terms of providing value-based healthcare for better outcomes for patients at a low cost. For instance, through December 31, 2021, the Center for Medicare and Medicaid Innovation adopted the initial Home Health Value-Based Purchasing Model. The concept was created to help Medicare-certified Home Health Agencies across the country improve the quality and efficiency of their treatment.
On the other hand, the institutional care model for healthcare is anticipated to be the growth driver for this market throughout the forecast period due to increasing technology, operational problems, rising consumer expectations, and new health conditions. As a result, there has been a continuous shift toward healthcare services that are value-based and patient-centered. Due to profitability, the number of patients treated, and lower financial risk, value-based healthcare services are driven by a focus on establishing integrated practice units, which measure outcomes and cost at the patient level, bundle prices, geographic expansion, and information technology platforms.
Some of the prominent players in the U.S. value-based healthcare service Market include:
Segments Covered in the Report
This report forecasts the volume and revenue growth at the country level and provides an analysis of the latest industry trends in each of the sub-segments from 2018 to 2032. For this study, Nova one advisor has segmented the U.S. value-based healthcare service market.
By Models
By Payer Category
By Providers’ Utilization Category
Chapter 1 Research Methodology & Scope
1.1 Market Segmentation & Scope
1.1.1 Estimates And Forecast Timeline
1.2 Research Methodology
1.3 Information Procurement
1.3.1 Purchased Database:
1.3.2 Nova one advisor’s Internal Database
1.3.3 Secondary Sources
1.3.4 Primary Research:
1.3.5 Details Of Primary Research
1.4 Information Or Data Analysis
1.4.1 Data Analysis Models
1.5 Market Formulation & Validation
1.6 Model Details
1.6.1 Mixed Approach Analysis (Model 1)
1.6.1.1 Approach 1: Mixed Approach
1.7 List Of Secondary Sources
1.8 List Of Primary Sources
1.9 Report Objectives
Chapter 2 Executive Summary
2.1 Market Outlook
2.1.1 U.S. Value-Based Healthcare Service Market Outlook, 2020 - 2032
2.2 Segment Outlook
2.3 U.S. Value-Based Healthcare Service Market Summary, 2023
Chapter 3 U.S. Value-Based Healthcare Service Market Variables, Trends & Scope
3.1 Penetration & Growth Prospect Mapping
3.2 U.S. Value-Based Healthcare Service Market Dynamics
3.2.1 Market Driver Analysis
3.2.1.1 Improved Chronic Health Condition Patient Management
3.2.1.2 Higher Incidence Of Chronic Non-Communicable Diseases
3.2.1.3 Rising Demand For More Integrated Care Delivery Models
3.2.1.4 Rising Organizational Restructuring Efforts
3.2.1.5 Rising Government Initiatives
3.2.2 Market Restraints Analysis
3.2.3 Unmet Needs/Opportunity Analysis
3.3 U.S. Value-Based Healthcare Service Market Analysis Tools: Porter’s Five Forces Analysis
3.3.1 Supplier Power: Moderate-High
3.3.2 Buyer Power: Moderate-High
3.3.3 Threat Of Substitutes: Low-Moderate
3.3.4 Threat Of New Entrants: Moderate- High
3.3.5 Competitive Rivalry: High
3.4 Pestel Analysis
3.4.1 Political & Legal Landscape
3.4.2 Social Landscape
3.4.3 Technology Landscape
3.5 Regulatory Framework
3.6 Covid-19 Impact Analysis
3.6.1 Current And Future Impact Analysis
3.6.2 Impact Of Covid-19 On Market Players
Chapter 4 U.S. Value-Based Healthcare Service Market: Models Estimates & Trend Analysis
4.1 Models Movement Analysis, 2023 & 2032
4.1.1 Pay For Performance
4.1.1.1 Pay For Performance Market Estimates And Forecasts, 2020 - 2032
4.1.2 Pay For Performance
4.1.2.1 Pay For Performance Market Estimates And Forecasts, 2020 - 2032
4.1.3 Patient-Centered Medical Home
4.1.3.1 Patient-Centered Medical Home Market Estimates And Forecasts, 2020 - 2032
4.1.4 Shared Savings
4.1.4.1 Shared Savings Market Estimates And Forecasts, 2020 - 2032
4.1.5 Shared Risk
4.1.5.1 Shared Risk Market Estimates And Forecasts, 2020 - 2032
4.1.6 Bundled Payment
4.1.6.1 Bundled Payment Market Estimates And Forecasts, 2020 - 2032
4.1.7 Capitation Models
4.1.7.1 Capitation Models Market Estimates And Forecasts, 2020 - 2032
Chapter 5 U.S. Value-Based Healthcare Service Market: Payer Category Estimates & Trend Analysis
5.1 Payer Category Movement Analysis, 2023 & 2032
5.1.1 Medicare And Medicare Advantage
5.1.1.1 Medicare And Medicare Advantage Market Estimates And Forecasts, 2020 - 2032
5.1.2 Medicaid
5.1.2.1 Medicaid Market Estimates And Forecasts, 2020 - 2032
5.1.3 Commercial
5.1.3.1 Commercial Medical Home Market Estimates And Forecasts, 2020 - 2032
Chapter 6 U.S. Value-Based Healthcare Service Market: Providers Utilization Category Estimates & Trend Analysis
6.1 Providers Utilization Category Movement Analysis, 2023 & 2032
6.1.1 Home Health Care
6.1.1.1 Home Health Care Market Estimates And Forecasts, 2020 - 2032
6.1.2 Institutional Care
6.1.2.1 Institutional Care Market Estimates And Forecasts, 2020 - 2032
6.1.3 Self-Care
6.1.3.1 Self-Care Market Estimates And Forecasts, 2020 - 2032
6.1.4 Hospital Therapy
6.1.4.1 Hospital Therapy Market Estimates And Forecasts, 2020 - 2032
Chapter 7 U.S. Value-Based Healthcare Service Market: Home Health Care Providers Utilization Category Estimates & Trend Analysis
7.1 Home Health Care Providers Utilization Category Movement Analysis, 2023 & 2032
7.1.1 Frontloading Skilled Nursing Visits
7.1.1.1 Frontloading Skilled Nursing Visits Market Estimates And Forecasts, 2020 - 2032
7.1.2 Specialized Frontloading Therapy Visits
7.1.2.1 Specialized Frontloading Therapy Visits Market Estimates And Forecasts, 2020 - 2032
Chapter 8 U.S. Value-Based Healthcare Service Market: Hospital Therapy Category Estimates & Trend Analysis
8.1 Hospital Therapy Category Movement Analysis, 2023 & 2032
8.1.1 Inpatient
8.1.1.1 Inpatient Market Estimates And Forecasts, 2020 - 2032
8.1.2 Outpatient
8.1.2.1 Outpatient Market Estimates And Forecasts, 2020 - 2032
Chapter 9 Competitive Landscape
9.1 Market Participation Categorization
9.2 Companies
9.2.1 Company Market Position Analysis
9.2.2 Major Deals & Strategic Alliances
9.2.3 Detailed List Of Players
Chapter 10 Company Profile
10.1 Baker Tilly US, LLP
10.1.1 Company Overview
10.1.2 Financial Performance
10.1.3 Product Benchmarking
10.1.4 Strategic Initiatives
10.2 Deloitte
10.2.1 Company Overview
10.2.2 Financial Performance
10.2.3 Product Benchmarking
10.2.4 Strategic Initiatives
10.3 Siemens Medical Solutions USA, Inc.
10.3.1 Company Overview
10.3.2 Financial Performance
10.3.3 Product Benchmarking
10.4 Boston Consulting Group
10.4.1 Company Overview
10.4.2 Financial Performance
10.4.3 Product Benchmarking
10.4.4 Strategic Initiatives
10.5 Change Healthcare
10.5.1 Company Overview
10.5.2 Financial Performance
10.5.3 Product Benchmarking
10.5.4 Strategic Initiatives
10.6 Athena Healthcare
10.6.1 Company Overview
10.6.2 Financial Performance
10.6.3 Product Benchmarking
10.6.4 Strategic Initiatives
10.7 Veritas Capital Fund Management, L.L.C.
10.7.1 Company Overview
10.7.2 Financial Performance
10.7.3 Product Benchmarking
10.7.4 Strategic Initiatives
10.8 UnitedHealth Group.
10.8.1 Company Overview
10.8.2 Financial Performance
10.8.3 Product Benchmarking
10.8.4 Strategic Initiatives
10.9 NXGN Management, LLC.
10.9.1 Company Overview
10.9.2 Product Benchmarking
10.9.3 Strategic Initiatives
10.10 McKesson Corporation
10.10.1 Company Overview
10.10.2 Financial Performance
10.10.3 Product Benchmarking
10.10.4 Strategic Initiatives
10.11 Genpact
10.11.1 Company Overview
10.11.2 Financial Performance
10.11.3 Product Benchmarking
10.11.4 Strategic Initiatives
10.12 Unlimited Technology Systems, LLC
10.12.1 Company Overview
10.12.2 Financial Performance
10.12.3 Product Benchmarking
10.12.4 Strategic Initiatives
10.13 ForeSee Medical, Inc.
10.13.1 Company Overview
10.13.2 Financial Performance
10.13.3 Product Benchmarking
10.13.4 Strategic Initiatives
10.14 Signify Health, Inc. (Sentara Healthcare)
10.14.1 Company Overview
10.14.2 Financial Performance
10.14.3 Product Benchmarking
10.14.4 Strategic Initiatives
10.15 Curation Health
10.15.1 Company Overview
10.15.2 Financial Performance
10.15.3 Product Benchmarking
10.15.4 Strategic Initiatives
10.16 Koninklijke Philips N.V.
10.16.1 Company Overview
10.16.2 Financial Performance
10.16.3 Product Benchmarking
10.16.4 Strategic Initiatives
Cross-segment Market Size and Analysis for
Mentioned Segments
Additional Company Profiles (Upto 5 With No Cost)
Additional Countries (Apart From Mentioned Countries)
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Go To Market Strategy
Region Specific Market DynamicsRegion Level Market Share Import Export AnalysisProduction AnalysisOthers