Value-based healthcare is no longer just a policy ideal—it’s a strategic and financial necessity. For both payers and providers, delivering better health outcomes at a lower total cost of care demands digital maturity, real-time data intelligence, and personalized care at scale.
With 90% of the nation’s $4.5 trillion annual healthcare spend directed toward individuals with chronic and mental health conditions, the need for preventive interventions and effective disease management has never been more urgent. When done right, value-based models can drive both significant cost savings and measurable improvements in population health.
In many markets, the lack of proactive, data-driven, value-based models results in rising costs, overburdened staff, and widening gaps in care. In contrast, organizations embracing a Value-Based Health Management (VBHM) strategy—powered by modern cloud platforms—are achieving transformative improvements in patient outcomes, cost efficiency, and regulatory compliance.
From Volume to Value – Why VBHC is Reshaping the Future of Healthcare?
Unlike traditional fee-for-service models that reward volume, Value-Based Health Care (VBHC) aligns financial incentives with improved clinical outcomes, enhanced patient engagement, and cost containment. For organizations operating in regulated markets or value-driven national healthcare frameworks, VBHC is critical for:
- Reducing revenue leakage caused by avoidable ER visits and care gaps.
- Optimizing resource utilization while minimizing provider burnout.
- Meeting regulatory reforms such as CMS ACOs (US), NHS Long-Term Plan (UK), or SEHA reform (UAE).
- Building patient trust and loyalty through superior care coordination and personalization.
In contrast to volume-driven models, VBHC rewards:
- Improved health outcomes
- Lower total cost of care
- Higher patient satisfaction
- Better provider efficiency
For payers, the benefits include a reduction in avoidable claims, improved Medical Loss Ratios (MLR), and enhanced member loyalty. For providers, it fosters clinical excellence, unlocks eligibility for performance-driven incentives (such as HEDIS, MIPS, or Star Ratings), and mitigates burnout through more streamlined workflows.
Mastek's VBHC Solution Framework with Salesforce: Powering the Future of Health
At Mastek, we’ve engineered a scalable VBHC architecture that orchestrates data, engagement, and clinical intelligence using Salesforce PaaS (Health, Marketing and Data Cloud).
To enable real-time care orchestration, we seamlessly integrate Salesforce Health Cloud with leading EMR systems such as Cerner Millennium, Epic, and InterSystems TrakCare. This integration allows the ingestion of:
- Clinical records including labs, vitals, diagnoses, and procedures
- Care plans and care team information
- Encounter notes and discharge summaries
The aggregated data builds a longitudinal patient record within Health Cloud, empowering care coordinators with unified insights to proactively manage chronic conditions like diabetes, hypertension, and chronic kidney disease (CKD).
1. Data Lake / Warehouse Integrations for Patient 360
We integrate Salesforce with enterprise data platforms like Snowflake, Azure Synapse, and AWS Redshift to build a unified Patient/Member 360 view by aggregating:
- Demographics and social determinants of health (SDOH)
- Claims and benefits history
- Utilization trends
- Behavioral and engagement data
This holistic view fuels AI-driven risk scoring, population stratification, and Next Best Action (NBA) recommendations to guide care teams.
2. Insurance & Benefits Verification Systems
Our platform supports real-time integration with payer systems to streamline:
- Eligibility verification
- Coverage and prior authorization checks
- Copay and formulary data retrieval
This ensures financially-informed, personalized care planning, reducing friction and minimizing dropouts due to uncovered services.
3. Telephony & Contact Center Integration (Genesys, Twilio, Avaya)
To enable value-based outreach, we integrate Health Cloud with leading contact center platforms such as Genesys Cloud, Twilio Flex, and Cisco UCCE, enabling agents to:
- Access patient/member profiles in real time
- Trigger automated reminders for screenings, vaccinations, or refills
- Log call outcomes and generate follow-up tasks
This supports omnichannel care coordination and ensures closed-loop communication.
4. Marketing Cloud Omnichannel Journeys – SMS, WhatsApp, Email, Chat
Using Salesforce Marketing Cloud, we deliver AI-personalized outreach across:
- SMS (via Twilio or WhatsApp for Business)
- Email for newsletters, appointment confirmations, and education
- In-app or web chat for self-scheduling and FAQs
This fosters preventive care compliance, care gap closure, and sustained engagement across the member journey.
5. Next Best Action (NBA) & AI-Powered Decision Engines
Powered by Salesforce Einstein and integrated machine learning models, our VBHC framework enables:
- Next Best Care Interventions based on individual risk, adherence, and predicted outcomes
- Propensity modeling for follow-up, screening, or educational interventions
- Adaptive care planning that incorporates clinical, behavioral, and social insights
AI also supports smart triage, task prioritization, and real-time alerts for high-risk populations.
6. Automated Clinical Events & Workflows
Leveraging Salesforce Flow and Health Cloud Care Plans, we automate key clinical workflows:
- Reminders for overdue HbA1c or retinal exams
- Alerts for out-of-range vitals (e.g., BMI, BP)
- Outreach triggered by medication non-adherence
- Referral workflows and care team notifications post-hospitalization
These automated processes are essential for closing care gaps and achieving value-based care metrics (HEDIS, ACO, QOF, etc.).
Our VBHC frameworks are built with regulatory alignment, ensuring audit readiness and seamless reporting across diverse governance landscapes.
Why is Mastek Your Ideal VBHC Partner?
Mastek delivers Salesforce Health Cloud implementations across global healthcare systems - tailored to regional needs and regulatory landscapes - powered by:
• Certified Salesforce experts with hands-on experience in complex health IT environments
• Healthcare domain consultants who understand payer, provider, and public health workflows
• AI/ML accelerators that enable rapid deployment of personalized care journeys, risk stratification models, and automated workflows
Together, these capabilities help health organizations streamline operations, improve patient engagement, and drive measurable outcomes in value-based care settings.
Charting the Path Forward in Value-based Healthcare
The shift to value-based healthcare isn't a question of if—but how fast and how well. As care models evolve and regulatory pressures mount, healthcare organizations must embrace a digitally mature, data-driven approach that places outcomes, efficiency, and patient experience at the core. Mastek's Salesforce-powered VBHC framework offers a proven, end-to-end solution to help payers and providers navigate this shift with confidence.
From clinical data integration and patient 360 insights to AI-driven decision support and omnichannel engagement, we enable organizations to deliver smarter care—faster, cheaper, and more compassionately.
Ready to lead in the era of value?
Explore how Mastek is helping healthcare leaders operationalize VBHC at scale.
