Reclaiming Healthcare Autonomy in an Era of Permanent Accountability

CMS has made its position unmistakable. New models like ACCESS and ACO Primary Care Flex signal a long-term commitment to chronic disease accountability, total cost of care, and equity. 

At the same time, a substantial share of healthcare revenue still flows through fee-for-service arrangements. Nearly 45% of healthcare payments remain fee-for-service, yet hospitals are already subject to readmission penalties, quality scoring, and cost benchmarks across your entire patient population.

Patients with uncontrolled chronic disease drive utilization and penalties across all lines of business. Whether they are attributed to MSSP, Medicare Advantage, or fee-for-service, the financial exposure accrues to the same balance sheet. When accountability is enterprise-wide but care strategies are contract-specific, organizations absorb risk they cannot actively manage.

This is the operating environment you are leading in, and it creates a strategic bind that traditional population health tools were never designed to solve.

‍

The Real Challenge: Accountability Without Alignment

For the past decade, population health strategy has been built around value-based care participation. Analytics platforms, care management teams, and reporting workflows were designed to support specific contracts.

That approach made sense when downside risk was limited and margins were forgiving. It breaks down in today’s environment.

According to a Kaufman Hall National Hospital Flash Report from 2024, around 40% percent of hospitals continue to operate with negative margins. At the same time, KKF reports that nearly 80% of hospitals face some form of quality-related penalty exposure. Chronic disease costs continue to climb, with the CDC estimating annual diabetes-related spending now exceeds $400 billion  in the United States.

These pressures do not discriminate by payment model.

Yet most health systems still operate population health programs that actively manage only a fraction of their patients. The rest remain in a reactive care model, despite driving a disproportionate share of avoidable utilization and cost.

This is not a data integration problem. It is a control problem.

‍

What Healthcare Autonomy Actually Means

Healthcare autonomy does not mean opting out of value-based care. It means refusing to let payer mechanics dictate your ability to act.

Autonomy is the ability to manage population health outcomes across your entire patient base, regardless of how those patients are reimbursed. It is the ability to apply the same rigor to a fee-for-service patient with rising A1c as you would to an attributed ACO beneficiary. Healthcare autonomy is the ability to improve outcomes first and align contracts second.

In practice, autonomy reduces financial risk by addressing utilization drivers before penalties and write-downs occur. It controls cost by standardizing care delivery across populations instead of fragmenting it by contract. And it strengthens competitiveness by allowing you to negotiate from demonstrated performance rather than projected potential.

This is the problem Innovaccer’s population health management stack is built to solve.

‍

The Population Health Management System Designed for Healthcare Autonomy

Autonomy and accountability are inseparable. When accountability expands faster than your ability to influence outcomes, it becomes financial exposure rather than control.

Innovaccer’s population health management system (PHMS) establishes control by unifying claims, EHR, lab, ADT, and workflow data into a single actionable view, so accountability can be managed in real time rather than reconciled after the fact.

With that visibility, care delivery stops being organized around contracts. Patients are prioritized based on clinical risk, utilization patterns, and quality exposure. Instead of running parallel strategies for MSSP, Medicare Advantage, and commercial populations, you operate a single approach applied consistently across all patients.

That structural shift translates into measurable performance. At Adventist HealthCare Physician Alliance (AHPA), population health analytics combined with automated care management workflows accelerated post-discharge intervention and standardized follow-up. 

Care navigators managed more than 400 hospital discharges, and avoided 150 readmissions in the first year. Transition-of-care protocols reduced MSSP readmissions by 15.8%. ED diversion protocols lowered expected total cost of care by more than 16%, generating over $1.8 million in savings.

Operationally, the shift delivers more precise decisions. Care teams work from a prioritized view of rising-risk and high-risk patients. CFOs, COOs, and clinical leaders track admissions, ED visits, readmissions, and PMPM trends as they evolve, not months after performance is locked in. 

Population health shifts from retrospective measurement to prospective intervention, changing not just how performance is measured, but how strategy is set.

You no longer ask whether a patient qualifies for intervention based on reimbursement structure. You ask whether intervention reduces avoidable utilization and downstream cost. A population health management system built this way allows you to control risk and utilization across the enterprise, regardless of payment model, and compete on outcomes rather than contract participation.

‍

From Population Insight to Clinical Control: Story Health by Innovaccer

Autonomy breaks down quickly if it stops at identification.

Chronic disease outcomes, especially in cardiometabolic conditions, are determined between visits. Studies consistently show that readmissions and disease progression correlate more strongly with gaps in follow-up and adherence than with in-clinic decision-making alone.

Story Health extends Innovaccer's PHMS into continuous specialty care.

When Innovaccer’s pop health tool identifies rising risk, Story Health enables daily engagement, remote monitoring, and AI-supported coaching for patients. This is the crux of operationalized follow-through.

Partnering with Story Health, Intermountain Health's heart failure program demonstrated 65% fewer hospitalizations and 53% less ED utilization compared to matched control groups, while achieving a 6X increase in guideline-directed medical therapy (GDMT) optimization within 90 days. The program also freed up more than three clinic slots per enrolled patient, enabling providers to extend capacity without adding resources.

More importantly, this capability applies across all patients. Not just those tied to downside contracts.

‍

Turning Clinical Performance into Financial Leverage: Humbi AI by Innovaccer

Improved outcomes only matter if you can translate them into financial decisions. That translation has historically been the weakest link between population health strategy and contracting.

Humbi AI closes that gap by bringing actuarial intelligence into your operating model. Instead of relying on lagging benchmarks or external assumptions, you evaluate risk, utilization, and margin impact using your own care delivery patterns.

This shifts contracting from retrospective reconciliation to forward-looking control. You see downside exposure earlier, test assumptions before they harden into contracts, and enter negotiations grounded in evidence rather than estimates.

That financial clarity is what allows healthcare autonomy to extend from care delivery into enterprise strategy.

‍

Healthcare Autonomy is the New Advantage

The healthcare industry is approaching a compliance cliff. Accountability is expanding faster than reimbursement alignment, and waiting for perfect payment structures is no longer a viable strategy.

Healthcare autonomy gives you a way forward. It allows you to manage chronic disease and utilization proactively, control financial exposure across contracts, and compete on outcomes rather than participation status.

Innovaccer provides the operating system to do exactly that. Not by replacing value-based care, but by giving your organization the ability to lead without waiting for it.