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# Value-Based Care Challenges, Emerging Value Models
- URL: https://marginsofcare.com/value-based-care-challenges-emerging-value-models/
- Published: 2026-09-09T19:42:57.000Z
- Updated: 2026-09-10T06:28:53.000Z
- Author: Eva Worst

The idea of value-based care is simple: if the purpose of healthcare is to restore our health, then this is how we should measure it and based on the impact is how we should pay for the procedures and services we get. The complexity comes from its implementation.

There are a few challenges that we need to solve before we can make the switch away from the current procedure-based reimbursement.

The first one is around **measurement**. To start with, it’s not always easy to define the endpoints and what success looks like. Then the question is how do you measure them - what measuring stick, what sources and over what timeframe (short- vs mid- vs long-term). Some things might not even be quantifiable - for example to what degree did I overcome my fear of bugs after 5 sessions at the doctor? Or how much more load can my knee take after the knee replacement three months ago? I can say I feel better, but I can’t possible put a number on it. And then there is the question of who validates the data accuracy and its meaning?

The second one is about **patient involvement**. A broken hand might not require much cooperation from the patient to heal, but many other maladies, especially when we look at the chronic diseases, require that patients adhere to strict treatment plans, such as taking their medication, going to therapy and doing life-style changes. Trying to implement a value-based approach for those cases - under which we can also include most prevention measures - without taking into account the collaborative nature of the process, is doomed to fail.

And the third one is about the ability to attribute **the correct degree of causality**. There are no two patient cases that heal/progress the same way. If two patients both get their appendicitis removed by the same doctor, but one leaves the hospital the next day while the other develop sepsis and stays at the ICU for 2 weeks - was the value provided different? People have preconditions and predispositions, and sometimes are just unlucky - and this has nothing to do with the value that was provided. Even people like Brian Johnson who are following a pathological/clinical-grade routine are eventually [falling victim](https://www.nytimes.com/2026/08/21/us/bryan-johnson-biohacker-autoimmune-gastritis.html) to their own biology.

### Emerging Value Models

Wearables that collect health data in an ongoing manner are one way to address at least part of the aforementioned challenges. Apple Watch, to take an obvious example, can already record all kinds of health markers that can be used to access treatment success in a long-term way. If this data can be included in the DRG system, that might be a way to go.

But given the difficulty and in some cases even impossibility to quantify an outcome, maybe we can entirely avoid tracking health outcomes on a patient-level and instead do it on a cohort/population level. This is what [Alan is doing](https://marginsofcare.com/alan-care-and-prevention-subscriptions/) with their flat-rate subscription model. Not only are patients included in the collaborative treatment process, they are also incentivised to participate, as they pay from their own pocket for it in a very visible way (as opposed to the automatic salary deductions that statutory health insurances typically have).

And finally on the MedTech side there are also a couple of emerging business models [centred around risk-sharing](https://www.deloitte.com/us/en/insights/industry/life-sciences/medical-device-business-model-payments.html). 

In any case, the field is poised for change and it’s going to be exciting to see what companies emerge at the top.