The Potential Implications of Informatics for Value-Based Bare.

OBJECTIVE: Value-based care (VBC) represents a fundamental shift from volume-driven reimbursement to models focused on improving patient outcomes and reducing costs. Informatics plays an essential, but often underappreciated, role in enabling VBC. Traditional discussions of informatics emphasize data and technology; however, a broader sociotechnical view highlights how people, organizations, workflows, and policies interact with technology to influence the success of VBC initiatives. In this article, we apply the Informatics Stack as a heuristic framework to examine how informatics shapes VBC across 4 phases: research, policy setting, healthcare implementation, and local assessment within learning health systems.

MATERIALS AND METHODS: We applied the Informatics Stack as a heuristic framework to analyze VBC across four phases: research, policy setting, healthcare implementation, and local assessment. To provide a grounded analysis, the study focused on the Healthcare Implementation phase, utilizing vascular claudication management as a primary illustrative case to demonstrate how high-level VBC policies are converted into granular clinical workflows and algorithms.

RESULTS: We present "As-Is" characterizations of informatics in VBC at multiple levels of the Stack, ranging from world-level regulatory forces to organizational values, to business processes, workflows, information systems, modules, algorithms, data, and underlying technologies. We also outline "To-Be" opportunities, including computable clinical guidelines, interoperable data platforms, algorithm performance monitoring, and integration of multimodal data streams into decision support. To provide a grounded analysis, we narrow our focus to the Healthcare Implementation phase, using vascular claudication management as our primary illustrative case. Managing claudication in a VBC model requires preventing low-value care, such as early, aggressive peripheral vascular interventions, while optimizing patient-specific outcomes. We will used this clinical example to walk down the levels of the Stack, demonstrating how informatics converts high-level VBC policy into granular clinical workflows and algorithm.

DISCUSSION: In this article, we apply the Informatics Stack as a heuristic framework to examine how informatics shapes VBC across four phases, specifically focusing on the Healthcare Implementation phase using vascular claudication management as an illustrative case. We present "As-Is" characterizations of the current state of informatics alongside "To-Be" opportunities, including computable clinical guidelines, interoperable data platforms, and algorithm performance monitoring. Concluding that VBC requires a socio-technical perspective beyond mere data and technology, we propose the Stack as a diagnostic tool for health leaders and offer a "VBC Informatics Gap Analysis Toolkit" to help organizations identify alignment gaps in their implementation strategies.

CONCLUSION: In teaching informatics and in generating an assessment of where a problem or a field is at any point in time, we have found the Stack to help students, universally, and many alumni, to apply in their work. However, for the health system leader attempting to implement VBC, the Stack must be more than a theoretical model; it must be a diagnostic tool. It does not prescribe specific software purchases, but rather points out to an organization where they may have inconsistencies in their conception of their informatics infrastructure or frank gaps in that conceptualization.