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By Rachael Rivero
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Americans deserve to know what their healthcare spending achieves. An appointment completed or a prescription filled represents necessary care, but neither tells us whether someone is healthier afterward.
I believe healthcare leaders, insurers, and policymakers should place greater emphasis on sustained improvements in patient health when evaluating performance and determining financial incentives.
Centers for Medicare & Medicaid Services shows that U.S. healthcare spending reached $5.3 trillion in 2024, rising 7.2 percent. Out-of-pocket spending increased 5.9 percent. Those figures describe a growing financial commitment. They should also prompt a question about its return.
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What improvements are patients receiving for that investment?
Healthcare already measures outcomes and ties them to financial incentives. Medicare’s 2026 Shared Savings Program standards include blood pressure control, diabetes management, and hospital admissions, with quality performance affecting financial rewards.
Diagnosing The Problem
The problem is not an absence of measurement. My concern is whether those measures adequately capture sustained progress and the everyday benefits patients value.
Consider the difference between recording a blood pressure reading and establishing that someone maintained an appropriate level over time. Or between documenting discharge instructions and learning whether a patient understood them, obtained the prescribed medicines, and recovered safely at home. Completing a task should begin an assessment of its value, rather than end it.
In my work with older adults and people managing multiple chronic conditions, I see how plenty of healthcare can coexist with confusion. A patient may have several specialists, regular appointments, and detailed instructions, yet still lack a clear plan or understanding. Measuring each encounter separately can leave the gaps between them overlooked.
Payment should support closing those gaps. Paying separately for visits and procedures creates a clear financial path for delivering them. The same clarity should extend to following up, reviewing conflicting instructions, and helping families carry out a plan. While Medicare already pays for chronic care management, there must be broader accountability to support what happens between appointments.
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Diabetes offers an example of why follow-through matters. My uncle brought his blood sugar under control, then understood that improvement to mean his diabetes had disappeared.
That misunderstanding resulted in later complications. His experience made me question how clearly we explain progress. The National Institute of Diabetes and Digestive and Kidney Diseases distinguishes remission from cure. Better results deserve recognition alongside education about maintaining them.
How To Review Medication
Medication review deserves similar attention. Clinicians should have time to assess whether each medicine remains necessary and whether its benefits still outweigh its risks.
The National Institute on Aging advises discussing medicines with clinicians and checking before stopping them. Safely reducing an unnecessary prescription can be a success. So can continuing an essential one. A lower prescription count alone would be a poor target.
A more useful assessment would follow patients over time, tracking sustained blood sugar and blood pressure improvements, preventing additional illness, and successful hospital discharges.
It should also ask whether people can manage daily activities, understand their treatment, and pursue goals they helped choose. For someone with progressive illness, maintaining function or reducing distress may be a meaningful achievement.
Patients also need room to explain what is getting in the way. A plan that assumes someone can afford a medication or travel to follow-up appointments may miss the reason progress has stalled. Asking about those difficulties, agreeing on realistic goals, and checking understanding should be part of the plan. Otherwise, a favorable laboratory result could conceal a treatment burden the patient cannot sustain.
Funding Must Support Follow-Ups
Prevention also requires careful interpretation. One person remaining disease-free does not prove a particular intervention prevented illness. Credible reporting should distinguish measured improvement from assumptions about what might have happened.
Insurers and policymakers should require a small, consistent set of long-term outcome measures in payment contracts, including patient-reported function and goals.
Healthcare organizations should assign responsibility for follow-up, review progress at agreed intervals, and report results alongside spending. Funding must realistically support that work rather than simply add reporting duties. Patients should help define success without becoming responsible for coordinating the entire system.
Without that shift, we risk funding more activity while leaving its value uncertain. Healthcare’s return should be visible in the lives people can lead.
Rachael Rivero is a nurse practitioner and founder of the care-coordination company Kansas Care Connect, and all opinions are the author’s own.
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