When we talk about value-based care (VBC), the conversation usually centers on care coordination, population health and quality metrics. Rightfully so — these are the pillars on which improved outcomes and shared savings are built. But behind the scenes, there’s another system that determines whether those models succeed or collapse: the revenue cycle.
For all the sophistication in our clinical innovations, too many providers are struggling to get paid. Claims rejections, slow reimbursements and complex payer requirements are more than back-office headaches — they’re obstacles to sustainability. In VBC models, where margins are tight and financial incentives are tied to outcomes, an inefficient revenue cycle can bring even the best care model to its knees.
We talk about population health and shared savings, but if claims don’t go through, providers can’t keep their doors open long enough to see those benefits.
The frontline of complexity
Nowhere is this tension more evident than in the community-based sector. Take home health agencies, for example — many of which are small, independent and deeply embedded in underserved communities. These providers are on the front lines of VBC goals, delivering preventative and post-acute care that keeps patients out of hospitals and improves quality of life. But their reward for this essential work is often a convoluted billing process that puts them at risk.
Consider what happened in Indiana when the state transitioned from a single Medicaid payer to a managed care model with multiple payers. Agencies that had long relied on a single billing workflow suddenly found themselves dealing with four different entities, each with its own portal, rules and claim formats.
One such organization, GEOH, an electronic visit verification (EVV) vendor providing home health care software and concierge billing services for Medicaid and the U.S. Department of Veterans Affairs (VA), experienced the disruption firsthand. Their team fielded daily calls on behalf of partner agencies during that challenging time, working directly with payers both online and in person. The agencies were under significant financial stress — not because they lacked patients or quality care, but because they couldn’t get paid.
These weren’t large hospital systems with entire departments dedicated to revenue cycle management — they were caregivers who had become business owners, now scrambling to navigate a system that changed overnight.
Infrastructure that adapts in real time
The turning point came when GEOH invested in smarter revenue cycle infrastructure — not just software, but scalable systems and support that could evolve with payer demands. They transitioned from manual billing to automated tools that allowed their team to edit 837 files on the fly, troubleshoot payer-specific errors and monitor rejections in real time.
The impact was immediate. Denials dropped, cash flow stabilized and agencies regained the financial footing they needed to focus on patients. What started as a survival mechanism soon became a strategic advantage. GEOH began hosting weekly billing webinars across three states, sharing lessons learned and helping others avoid the pitfalls they’d faced.
They didn’t just fix their own system — they built a platform for others to succeed. Today, GEOH now delivers end-to-end billing support to more than 270 agencies. That’s the power of resilient revenue infrastructure: it scales knowledge, not just transactions.
When financial stability enables clinical stability
The connection between RCM and clinical outcomes is often overlooked. But in a value-based model, where care coordination and longitudinal engagement are key, the stakes are higher. If a provider can’t afford to retain staff or expand services because of delayed payments, patients suffer.
An efficient revenue cycle isn’t just about reducing denials — it’s about enabling care continuity. According to the CAQH Index, administrative complexity continues to cost the healthcare system billions annually, with eligibility and claim submission errors among the most time-consuming burdens for providers. When agencies know they can count on timely reimbursement, they can invest in workforce development, adopt innovative care models and meet the reporting requirements that VBC contracts demand.
In GEOH’s case, stabilizing the billing process didn’t just save their business — it allowed them to double their reach. Their partner agencies maintained continuity of care for thousands of patients, many of whom would otherwise have ended up in higher-cost settings like emergency rooms or hospitals.
Claim rejection isn’t just an administrative problem — it’s a disruption in someone’s care journey.
Revenue cycle as an equity enabler
There’s a larger story here about equity. As the healthcare system continues its shift toward VBC, there’s a real risk that only large, well-capitalized organizations will be able to participate. Without the resources to invest in robust billing infrastructure, smaller providers — especially those serving Medicaid populations — may be left behind.
This isn’t just a tech issue. It’s a structural challenge that determines who gets to compete and who gets shut out. If we want a healthcare system where community-based agencies can thrive, we need to prioritize infrastructure that supports them.
That includes payment systems that are flexible, transparent and supportive — not punitive. It means building tools that work with providers, not against them. And it requires clearinghouses, EHR vendors and payers alike to recognize their role in shaping access — not just to payment, but to participation in the future of care.
Reframing what counts as “value”
We’ve spent years refining what “value” means in value-based care: better outcomes, lower costs, improved patient satisfaction. But value doesn’t happen in a vacuum. It’s built on systems that must be functional, reliable and adaptable — especially when the rules change or the players shift.
In that context, revenue cycle management isn’t just a support function — it’s a critical enabler. And when done right, it can be the quiet force that keeps the entire value-based care engine running.
We need to broaden the conversation to include the systems behind the scenes: the ones that ensure providers get paid, patients get seen and value-based models can actually deliver on their promise.
About the author
Rob Stuart is the founder and president of Claim.MD. With more than four decades of experience in healthcare data exchange, he has dedicated his career to simplifying the way providers and payers communicate, with a focus on access, efficiency, and sustainability.
Sponsored by
Claim.MD is a trusted EDI clearinghouse connecting providers nationwide to Medicare, Medicaid, Blue and commercial payers. With powerful, affordable tools and a provider-first design, we simplify clean claims submission and streamline revenue cycles.
Source: Modern Healthcare, Rob Stuart, Claim.MD, May 1, 2025
