Value-based care is one of the most serious attempts the healthcare system has made to align cost with outcomes. Recent playbooks and platforms rightly focus on reducing fragmentation, improving data quality, and giving providers and payers clearer insight into performance. From that perspective, the push toward better infrastructure is both necessary and overdue.
But there is a quiet gap running through much of this work.
Value-based care still largely operates on what the system can see — claims, utilization, contracts, and reconciled outcomes. What it often misses is what the patient knows long before any of that data exists: how they actually feel.
According to recent industry analyses from Arbital Health, many value-based care initiatives struggle not because the idea is flawed, but because the supporting data arrives late, is incomplete, or is difficult to act on in time. That diagnosis is correct. What’s missing is an acknowledgment that the earliest, most immediate signal doesn’t come from claims data at all — it comes from the patient.
Claims tell a story. Symptoms tell it sooner.
Claims are retrospective by nature. They confirm that something already happened: a visit, a prescription, a procedure, a hospitalization. They are invaluable for understanding cost, utilization patterns, and system performance over time.
Symptoms, by contrast, are leading indicators. They show up before the visit, before the escalation, before the intervention. Fatigue, weakness, nausea, dizziness, changes in appetite or heart rate — these are not abstract data points. They are the body signaling that something is off, often days or weeks before the system registers a problem.
In today’s value-based care models, that signal is rarely captured in a structured, durable way. At best, it appears fleetingly in a phone call or a clinical note. At worst, it never enters the record at all.
The system ends up optimizing around what it can measure, not what actually matters in the moment.
When the data arrives after the crisis
Midway through treatment, I started feeling profoundly weak. My heart rate was high. I wasn’t eating or drinking much. I knew something wasn’t right, but over the phone, there wasn’t much the care team could do. There was no shared place for those symptoms to live — no clear pattern visible beyond my own day-to-day experience.
By the time I was seen in person, I was already crashing. Fluids were started immediately. I spent that visit bent over a garbage can, nauseous and depleted, feeling far worse than I had days earlier when the symptoms first appeared.
From the system’s perspective, the data likely looks clean: an office visit, an intervention, appropriate care delivered. From the patient’s perspective, the most important information arrived too late to prevent the escalation.
That gap — between lived experience and recorded data — is where value-based care still struggles.
Infrastructure solves reconciliation. It doesn’t solve invisibility.
Modern value-based care platforms are doing important work. They reduce manual reconciliation, unify fragmented data, and give organizations a clearer picture of financial and clinical performance over time. This matters. Without that foundation, contracts fail, trust erodes, and teams spend more time arguing with spreadsheets than improving care.
But even the best infrastructure still operates above the patient, not with them.
If the system only becomes aware of deterioration once it shows up in claims or encounters, then value-based care remains reactive by design. It rewards managing outcomes after the fact, not preventing decline before it becomes acute.
The irony is that the missing data already exists. It just isn’t owned, structured, or protected in a way that allows it to be used.
What changes when symptoms are first-class data
Patient-reported symptoms are not noise. They are context. They explain why utilization happens. They reveal patterns that claims alone cannot show. Most importantly, they belong to the person experiencing them.
When patients have a simple, private way to track how they feel over time — without turning that data into a commodity — several things change:
- Patterns emerge earlier, before escalation
- Conversations with clinicians become clearer and more grounded
- Care decisions are informed by lived experience, not just historical utilization
- “Value” starts to include stability, clarity, and prevention — not just cost control
This doesn’t replace value-based care infrastructure. It completes it.
Value starts before the claim exists
Value-based care is often described as a shift from volume to outcomes. A more precise description might be this: a shift from what is easy to measure to what is worth understanding.
Right now, the system is still much better at measuring what happens after the fact than listening to what patients know in real time.
If value-based care is going to fulfill its promise, it has to move closer to the source of truth — not just cleaner data pipelines, but earlier signals. Not just unified dashboards, but patient-held clarity.
Because long before a claim is filed, a body is already telling its story.
And we should be listening.
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