The Next Phase of Value-Based Care: From Evidence to Implementation
In this interview, guest expert Lynn Carroll discusses how health plans are evaluating innovative therapies through the lens of value-based care and explains why real-world evidence, interoperable data, and scalable contract infrastructure are essential to expanding value-based agreements and improving patient outcomes.
Lynn Carroll: My name is Lynn Carroll, and I serve as chief operating officer and head of strategy at HSBlox. My background spans health care payments, insurance, and alternative payment models. Today, my work focuses on helping health care organizations operationalize value-based care through scalable contract administration, data exchange, bundled payments, and payer-provider collaboration.
How are health plans' views on trade-offs involving innovative therapies changing in today's market?
Carroll: Health plans are becoming more willing to consider trade-offs when affordability, access, and outcomes can be connected in a measurable way. The conversation has shifted from evaluating whether a therapy is clinically effective to determining whether it improves outcomes across the total cost of care and supports a broader population health strategy. Payers are more receptive to innovative therapies when manufacturers can reduce uncertainty through outcomes-based agreements, real-world performance measures, and clear alignment with disease management, care coordination, and high-cost specialty utilization priorities.
In my view, the biggest change is that health plans are looking for value that can be operationalized—not merely modeled—through trusted data, transparent benchmarks, and contract structures that distribute risk appropriately.
What types of clinical or economic evidence are most useful to payers when they evaluate innovative therapies?
Carroll: From a value-based care perspective, the most useful evidence helps payers understand how a therapy performs in real-world clinical practice and how it affects total cost of care, quality, and outcomes over time. Clinical trial data remains foundational, but payers increasingly seek complementary real-world evidence, longitudinal patient data, adherence and persistence measures, utilization patterns, reductions in avoidable events, and evidence of effects on disease progression.
Economic evidence is strongest when it links clinical outcomes to measurable cost savings or cost avoidance across the continuum of care, including primary care, specialty care, diagnostics, pharmacy, behavioral health, and social determinants of health. Manufacturers that support these evaluations with interoperable, permission-based, accurate, and timely data will be better positioned to demonstrate value.
How can manufacturers better align their market access strategies with value-based care goals?
Carroll: Manufacturers can better align their market access strategies by focusing on priorities shared by payers and providers, including improved outcomes, reduced avoidable utilization, enhanced care coordination, and lower total cost of care. That means incorporating measurable outcomes, data exchange requirements, patient engagement support, and practical contract terms from the outset. The strongest strategies make value-based arrangements easier to administer and scale without creating unnecessary administrative burden.
What barriers still limit broader adoption of value-based agreements, and where do you see the greatest opportunity?
Carroll: The greatest barriers include operational complexity, fragmented data, limited interoperability, inconsistent quality measures, and the difficulty of attributing outcomes and distributing financial risk across multiple stakeholders. Although many organizations want to transition to value-based models, they often lack the infrastructure needed to administer complex contracts, exchange data, reconcile performance, and accurately distribute payments.
The greatest opportunity lies in building scalable, trusted infrastructure that supports multiparty programs, transparent contract administration, and repeatable value-based care models that improve outcomes, patient experience, and cost trends.
