Value-Based Care Framework for Evaluating Digital Health Startups
Introduction
The digital health landscape is evolving rapidly, drawing the attention of risk-bearing entities eager to embrace tech-enabled solutions that promise to transform care models and achieve Quintuple Aim outcomes. However, while the potential of digital health innovations is vast, the rapid proliferation of tools has introduced unique challenges that can hinder their effectiveness.
A recent survey by the Peterson Health Institute highlights that spending on digital health has surged in the past two years, exacerbating care fragmentation and contributing to "point solution fatigue." Instead of simplifying workflows, these innovative tools often add layers of complexity to both clinical and administrative processes.
For payers and providers managing risk, evaluating digital health solutions is a critical yet complex task. Startups often present compelling cases, showcasing innovative solutions that seem aligned with the goals of value-based care. However, a closer examination frequently reveals challenges that undermine their practicality.
Many tools fail to integrate seamlessly into existing workflows, operating in silos and creating additional administrative burdens that complicate performance tracking.
Others present overlapping functionalities, making it difficult for organizations to attribute impact accurately or determine true value. Additionally, without proper vetting, organizations risk deploying tools that fail to deliver incremental value or align with their financial and operational goals.
These challenges highlight the need for a comprehensive evaluation framework that considers immediate organizational needs while ensuring alignment with long-term value-based care objectives. To navigate these complexities, healthcare organizations must adopt a value-based approach to evaluating digital health startups.
Traditional assessments that focus solely on return on investment (ROI) through one metric may not be sufficient. Instead, organizations should begin by reflecting on their current state, including existing infrastructure and outcomes, to determine how a proposed solution will complement or enhance their capabilities.
A detailed understanding of the proposed intervention along with a clear path to patient identification and activation are necessary to pressure test incremental value created.
Scaling solutions beyond a pilot must ensure it delivers tangible improvements for a target population at a price point that justifies its adoption. Solutions that directly or indirectly enhance revenue—whether through improved documentation, optimized coding, or higher quality scores—offer additional appeal and may supplement affordability value.
Decision-makers must also evaluate the sustainability, pressure-testing assumptions around program duration and retention rates to ensure long-term viability. By considering these factors, organizations can make informed decisions that align with their operational priorities and population health goals while mitigating risks and maximizing the impact of their investments.
The Quintuple Aim Framework for Evaluation
Recognizing these challenges and opportunities, Quintuple Aim Solutions has developed a draft rubric designed to support risk-bearing entities evaluate digital health startups with precision and clarity. Drawing on decades of experience partnering with payers, payviders, and providers, this framework enables decision-makers to assess startups comprehensively, identifying their strengths, weaknesses, and alignment with organizational goals.
The rubric employs an A-F rating scale, allowing evaluators to rate solutions across critical dimensions such as integration capabilities, operational efficiency, outcome alignment, scalability, and financial viability. This comprehensive approach not only identifies where a startup excels but also highlights areas for improvement, ensuring decision-makers can make informed choices that align with their value-based care objectives.
At Quintuple Aim Solutions, our commitment to advancing value-based care is unwavering.
Over the past two years, we have engaged nearly 500 startups at various stages of maturity, gaining unique insights into the challenges and opportunities of the digital health landscape. This work has underscored the importance of structured evaluation processes that simplify decision-making while addressing the inherent complexities of this rapidly growing space. We welcome feedback on our draft evaluation rubric to integrate other domains and organization priorities.
The goal is to collectively use common evaluation metrics and feedback for the innovation ecosystem to flourish and ultimately pave the way for a more integrated and patient-centered healthcare system.
Guiding Principles for Rubric Application
The rubric is more than a tool for evaluation—it is a resource for fostering robust partnerships between startups and risk-bearing entities. Evaluators should consider the following principles when applying the rubric:
Conclusion
The rapid growth of digital health presents both opportunities and challenges for risk-bearing entities seeking to achieve Quintuple Aim outcomes. With a structured framework for evaluation, payers, providers, and payviders can identify solutions that drive meaningful improvements in healthcare delivery.
At Quintuple Aim, our mission is to support the development and scaling of digital health startups that align with value-based care principles. By leveraging our deep industry expertise and relationships, we empower stakeholders to make informed decisions that lead to integrated, patient-centered care. For startups aiming to excel in these metrics, we offer guidance to build sustainable, impactful solutions that transform the healthcare ecosystem.
By adopting this rubric and a thoughtful, value-based approach, we can collectively accelerate the shift toward a more effective, equitable, and outcomes-driven healthcare system.
Written By: Reza Alavi, MD, MHS, MBA and Shreya Jain, MBS at Quintuple Aim.
