5 forces disrupting healthcare performance today — and how to navigate them

1. Cost pressure and the need for sustainable revenue

As the cost of delivering care continues to rise, health systems are under pressure to protect margins without compromising quality. Traditional fee-for-service models often drive increased revenue by incentivizing the volume of services, driving up spend — but even value-based care organizations must continuously find ways to control costs and grow revenue.

The key to both? A proactive patient engagement strategy.

Engaged patients are more likely to seek preventive care, follow through on treatment plans, and avoid unnecessary utilization — all of which reduce downstream costs. At the same time, thoughtful engagement drives timely revenue capture through closed care gaps, better visit adherence, and improved performance on quality measures tied to reimbursement.

Organizations succeeding in this space aren’t waiting for patients to show up — they’re reaching out with purpose. They’re:

• Segmenting populations based on risk, demographics, and preferences
• Using digital tools to connect patients to care teams at critical moments
• Embedding engagement into care coordination, not as a standalone initiative, but as a foundational strategy

When organizations treat patient engagement as a revenue lever — not just a communications effort — it becomes an even more powerful tool. And whether you're fully transitioned to value or still navigating fee-for-service, that multiplier effect is critical.

2. Workforce shortages and burnout

The healthcare workforce is in crisis. Nearly two thirds of U.S. nurses report symptoms of burnout, and experts predict a shortage of 100,000 critical healthcare workers by 2028. This impacts quality, safety, and organizational stability. Staffing challenges are systemic, and they directly threaten the quality, safety, and continuity of care. When clinicians are stretched too thin, it leads to longer wait times, rushed decisions, and costly errors. And as turnover accelerates, organizations face rising labor costs, fractured teams, and declining morale.

Forward-looking organizations aren’t waiting for the crisis to deepen. They’re taking proactive steps to shore up their workforce by investing in:

• Technology that automates manual workflows and reduces administrative burden
• Analytics to identity high-performing providers and allocate resources efficiently
• Culture-building initiatives that prioritize retention and mental health
  

3. Constant regulatory change

Regulatory complexity is accelerating — and the stakes keep rising. From evolving CMS benchmarks to shifting reimbursement rules, healthcare organizations are facing a wave of policy changes that are reshaping how care is delivered, measured, and paid for.

But this isn't just business as usual. Political shifts are intensifying the pace and impact of regulation, as federal priorities swing between value-based care expansion, cost containment, and health equity enforcement.

What once felt like incremental policy updates now carry immediate operational and financial consequences. Organizations must not only keep up — they must anticipate the ripple effects of reforms like:

• New ACO REACH participation requirements
• Star Ratings updates that directly affect incentive payments
• Health equity measures moving to the forefront of quality reporting

4. Interoperability is no longer optional

Fragmented data systems limit care coordination, create blind spots, and slow decision-making. But as care continues to move beyond the four walls of the hospital — into the home, community, and digital front door — these gaps have more serious consequences.

Clinicians need complete, timely data to make informed decisions. Care managers need a clear view across settings to close gaps. And leaders need accurate insights to measure performance, improve equity, and stay compliant with emerging regulations.

True interoperability — the seamless exchange of health data across systems — is now table stakes.

VBC leaders are forging ahead by:

• Integrating clinical, claims, and SDOH data into a single platform
• Leveraging APIs and FHIR standards to connect with partners
• Enabling real-time alerts for critical care events

5. Accurately predicting risk

Risk adjustment drives performance in VBC models — but too often, organizations rely on outdated or incomplete data. This leads to missed opportunities and financial penalties. Without accurate, timely insights, high-risk patients go uncaptured, leading to underpayment. Suspect conditions may never be addressed. HCC coding opportunities are lost, and care gaps remain hidden. The result could be millions left on the table — and potential penalties when coding accuracy or quality performance doesn’t meet CMS expectations.

In short: poor risk adjustment isn’t just a data problem. It’s a revenue problem, a compliance risk, and a barrier to better care.

Organizations with advanced analytics capabilities can:

• Identify rising-risk patients before costly events occur
• Align coding and documentation to actual patient acuity
• Optimize care management strategies for ROI
  

Moving forward: Equip your organization to lead

Disruption isn’t a moment — it’s a constant. But the most successful healthcare organizations aren’t waiting for stability. They’re building resilience now.

Dive deeper into these challenges in 10 vital strategies to excel in value-based care, our latest white paper with actionable guidance for any organization — whether you’re all-in on VBC or exploring how to make the shift.