Value-based care software in 2026: a buyer's guide and vendor comparison.

What changed in 2026

Start with three dated items, because they move the ground the vendors are standing on.

• The Star Ratings measure set is shrinking. The CY2027 Medicare Advantage and Part D final rule, published April 6, 2026, removes 11 measures from Star Ratings calculations beginning with the 2027 measurement period. CMS did not finalize removal of the Diabetes Care Eye Exam measure, added a depression screening and follow-up measure from the 2027 measurement year that first shows in the 2029 Star Ratings, and kept the longstanding reward factor instead of a Health Equity Index reward. Fewer measures means each surviving one carries more weight per gap. (Federal Register)
• CMS started paying for chronic care between visits. The CMMI ACCESS Model pays technology-enabled chronic care against measurable outcomes rather than per service. Cohort 1 began July 1, 2026 and CMS selected roughly 150 participants (STAT, April 13, 2026).
• HEDIS has two dates, not one. NCQA is retiring the hybrid method by measurement year 2029, with measures moving to administrative-only or ECDS reporting on a published schedule, and its stated goal is fully digital HEDIS by MY 2030, where a digital quality measure ships as computable specifications in HL7 FHIR and CQL rather than a PDF each vendor codes on its own. A vendor that talks about only one of those dates is describing half the job. (NCQA)

Two ownership facts also changed underneath this table and are easy to miss. Cotiviti completed its acquisition of Edifecs on March 31, 2025, so Edifecs is a Cotiviti business, and Cotiviti has had a new CEO, Ric Sinclair, since March 16, 2026. Nordic Capital took a majority stake in Arcadia on July 2, 2025. A buyer's guide that does not know who owns whom is not much use in a renewal conversation.

Vendor comparison

The table below groups representative vendors by what they are built to do. Categories are descriptive, not pejorative: a strong analytics platform and a strong execution layer solve different problems, and many organizations run more than one.

The decision underneath the decision

Search for "best value-based care software" and you get a list of vendors that look interchangeable. They all promise population health, risk adjustment, quality, and care management. The category labels hide the only distinction that changes your operating model: does the software tell you what to do, or does it do the work?

Analytics and data platforms unify your feeds, compute risk scores, surface care gaps, and render dashboards. They are very good at answering "where is the problem." Execution layers act on that answer: they make the outreach call, book the visit, draft the point-of-care documentation prompt, and operate payer portals the way a staff member would. Both functions matter. Confusing one for the other is how organizations end up paying for insight they cannot operationalize.

If you are evaluating Innovaccer alternatives, the most useful first question is not "who else does what Innovaccer does." It is "is my bottleneck visibility, or is it follow-through?" If your teams already know what to do and cannot get it done at volume, more analytics will not help. You need execution.

Innovaccer makes the unified-platform case about as well as it can be made, and the case is sound. One data model across risk and quality means you are not paying twice to retrieve the same chart, and a platform built FHIR-native has less rework ahead of NCQA's MY 2030 digital HEDIS target. Grant all of that. The choice a buyer is actually making is not between one data model and many. It is between buying a foundation and buying follow-through. If you have no unified data, buy the foundation first, and this guide will not talk you out of it. If your teams already know exactly what to do and the calls are not getting made, more foundation will not fix that.

How to choose: five criteria

1. Execution vs. analytics

This is the dividing line. Analytics platforms show the gap. Execution layers close it. A useful test: ask the vendor to walk through what happens after a care gap is identified. If the answer ends at "it appears on a worklist for your staff," that is analytics. If the answer includes "the platform places the call, schedules the appointment, and updates the record," that is execution.

2. Real-time vs. retrospective

Retrospective tools work on data that has already settled: submitted claims, completed encounters, closed chart-review projects. They are essential for audit and recovery. But under V28, capture decisions that happen after the encounter are decisions made too late. Read our V28 readiness playbook for why pre-claim, point-of-care flagging now beats end-of-year chart chases. Ask whether the system acts before the submission window closes or only reconciles after.

3. One canonical record vs. 8 to 15 point vendors

A risk-bearing organization commonly runs separate tools for risk, quality, pharmacy, network, care management, and BI. Each sees one slice. The cost is not just license fees. It is duplicate outreach to the same member by three teams in the same week, and no single view of what each team is doing. A single canonical record per member removes that coordination tax. The trade-off is depth in any one function versus coordination across all of them.

4. Time-to-value: weeks vs. months

Enterprise data platforms typically run multi-quarter implementations, because they normalize every source feed before value appears. Point tools deploy faster but cover one function. Ask for a specific date when a measurable outcome will appear, not a go-live date for the data warehouse. A forward-deployed model can stand up a working copilot in weeks by building one record from existing feeds rather than rebuilding the warehouse first.

5. Compliance: SOC 2 Type II and HIPAA

Any vendor touching PHI needs a Business Associate Agreement and HIPAA controls. For AI vendors specifically, ask for a SOC 2 Type II report, not Type I. Type I attests that controls exist on a single date; Type II tests that they operated effectively over a period, usually 6 to 12 months. Also ask whether every AI action carries a full, retrievable audit trail. That is what makes an automated action defensible later.

Innovaccer

Innovaccer's core strength is enterprise data unification. Its Data Activation Platform normalizes data from many sources using a unified data model and applies the company's own data-quality rules before serving analytics and applications. It launched Galaxy on October 14, 2025, an AI platform with specialized agents aimed at payer risk adjustment and HEDIS workflows, and on February 4, 2026 took Best in KLAS in three categories: Gravity at 93.2 for provider data and analytics, Galaxy at 90.5 for payer data analytics against a category average of 87.2, and Cured at 90.1 for CRM. On April 15, 2026 it said it is moving from software-access fees to outcome-based, per-task pricing, citing roughly $20 per prior authorization against a roughly $100 manual cost, and committing $250M over three years to its Gravity agent platform. That pricing move belongs in your time-to-value criterion below, because it changes what you are buying and when you pay for it. If your goal is to standardize a large organization on one data and analytics foundation, Innovaccer is a serious enterprise choice. The trade-off is the scope and timeline of a platform of that size. (Sources: Innovaccer Data Activation Platform; Galaxy announcement; MedCity News on per-task pricing.)

Arcadia

Arcadia is a data-platform and analytics company built on a healthcare data lakehouse that curates EHR, claims, SDoH, pharmacy, and ADT data into a longitudinal record. NCQA granted it Certified Data Partner designation in the Data Aggregator Validation program on July 31, 2024, and Nordic Capital took a majority stake on July 2, 2025. It has pushed into workflow since: Network Modeler and Contract IQ in February 2025, then AI-enabled care management in October 2025 with a prioritization engine and predictive workload balancing for case managers. It is a good fit when the priority is a clean, queryable data foundation and a well-ordered queue across a large population. Like other enterprise platforms, it is built to produce the insight and order the queue; executing the outreach is left to your teams. (Source: Arcadia data platform.)

Navina

Navina is a clinician-first AI copilot. It summarizes patient data from the EHR, HIE, and claims, then surfaces suspected conditions and care-gap evidence at the point of care, with one-click documentation inside the chart. It raised a $55M Series C led by Growth Equity at Goldman Sachs Alternatives on March 25, 2025, and its copilot ranked number one in Best in KLAS for clinician digital workflow in 2025; the 2026 award in that category went to TransformativeMed, so date any KLAS claim you see for Navina. For physician groups whose primary lever is what happens during the visit, Navina is well designed. It was built for the exam room and the clinician, and it does not try to cover the non-clinical teams that touch the same member. (Source: Navina risk adjustment.)

Reveleer

Reveleer was built for high-volume retrospective work and has spent two years buying its way out of that description, so update your notes if they still say chart review. Its Evidence Validation Engine automates chart retrieval, parses records, and populates abstraction fields for HEDIS abstraction and RADV/IVA submissions, joined by an all-in-one RADV audit workflow on October 15, 2025. Curation Health, acquired October 8, 2024, brought 1,400 clinical rules and Epic, Cerner, and Athenahealth integrations. Novillus, acquired April 22, 2025, brought care gap management and provider engagement. EVE Hybrid AI, announced January 20, 2026, does prospective diagnosis suspecting. And on April 7, 2026 it launched a Clinical Data Repository billed as a unified, AI-enriched member-level clinical record across risk adjustment, quality, RADV response, and care management. For a plan running scaled retrieval, quality, and audit programs, Reveleer is a strong fit with a wider footprint than its reputation. The distinction that still holds is between holding one record and working one queue. (Sources: Reveleer EVE; Clinical Data Repository, April 7, 2026.)

Pearl Health

Pearl Health enables independent primary care in traditional Medicare risk. It aggregates practices into ACOs, administers contracts, and gives providers predictive insight to focus on the patients who need attention most across MSSP and ACO REACH. Its 2026 product pillars are Performance Intelligence and Care Orchestration, the second of which automates annual wellness visit scheduling and post-discharge follow-up, so the older description of Pearl as insight-only is out of date. It raised $110M on July 8, 2026, $50M in equity led by a16z plus $60M in debt from Trinity Capital, reporting 10,000+ providers across 40 states, 250,000+ beneficiaries, and profitability since 2025. For a primary-care-led organization entering or scaling Medicare risk, Pearl is purpose-built and increasingly operational. Its reach still stops at the practices it enables, short of every team inside a risk-bearing organization. (Sources: Pearl Health technology; MedCity News, July 2026.)

Stellar Health

Stellar Health takes a distinctive approach: it pays providers and their staff in near-real-time for completing high-value actions, translating claims-derived gaps into granular "Stellar Value Units" inside the daily workflow. For networks that want to motivate manual completion of VBC actions with transparent monthly incentives, it works well. Its 2026 news was all leadership, a new CFO in March and a new CTO in May, and there has been no funding round since its 2021 Series B, so this description stands. The model rewards a person for doing the action, which is a different design choice from automating the action itself. (Source: Stellar Health for providers.)

Everyone claims execution now. Four tests that tell the claims apart.

Two years ago the argument was analytics versus execution, and one side was making it. In 2026 the incumbent argues follow-through as well. Innovaccer themed its June conference "AI That Executes" and publishes its own comparison pages on gap closure. New entrants say the same thing. League's Spring '26 release on March 3, 2026 added a Care Gaps Agent Team that checks coverage and provider availability and books appointments. Linear Health sells care gap closure automation to FQHCs and clinic networks: it ingests payer gap files, reaches patients by voice, SMS, and email, books into the EHR, and documents back to the chart, stating up to 90% of coordination work automated and first patient contact in about five minutes. blueBriX markets an AI agent with full-stack execution across EHR, revenue cycle, care coordination, and patient engagement.

We were making the execution argument before the phrase got crowded, and the crowding is real. It also means the phrase now carries no information on its own. The useful question is narrower: after a gap opens, what is the next action, who performs it, in what system, and how long does it take. Four questions get you there.

1. Which channel, and who operates it. Phone, SMS, portal, pharmacy, EHR, in-home. Go channel by channel and ask whether the vendor's software performs the work or your staff does. A list of channels is a list of places work can happen, not a claim about who does it.
2. Time from event to first contact. Hours from the gap opening or the ADT message landing to the first attempt. Ask for the median from a live customer, not the capability.
3. Where the evidence is written back. A closed gap that lives only in the vendor's workspace does not help you at reporting or in an audit. Name the receiving system and the lag.
4. One shared queue or one per program. If risk, quality, pharmacy, network, and care management each work their own list, the same member gets three calls in a week and every team reports success.

Ask for those four as a walkthrough on your own data, not a slide. Reveleer's 2026 survey with Mathematica and Harris Poll, fielded in March 2026 across 200 senior payer and provider decision-makers, found 93% report vendor overpromising and 94% of providers still rely on manual value-based-care processes (Reveleer, July 7, 2026). Arcadia's survey of 281 leaders, published June 16, 2026, found 14% say AI insights are fully integrated into the decisions that matter. Both come from vendors on this page, which is what makes them worth quoting.

Where an AI execution layer fits

The vendors above are strong at what they were built for. The gap most risk-bearing organizations feel is not a missing dashboard. It is that knowing the gap and closing the gap are two different jobs, and the second job is where staff time disappears.

Pelica is the execution layer. One canonical record per member, built from claims, EHR, pharmacy, lab, ADT, payer SFTP feeds, and call recordings, sits under six role-specific copilots: Risk Adjustment, Quality & Stars, Pharmacy & Part D, Provider Network, Care Management, and an AI Data Analyst. On top of that record is an action layer: outbound voice, EMR overlays, a provider portal, and a coder workspace, plus voice and computer-use agents that operate payer portals and EHRs the way a person would. The point is not to show the work. It is to do it.

At our flagship customer, a physician-led IPA in New York running risk on roughly 200,000 patients, the platform reached 100% team adoption and saved about 10 hours per user per week. Across Pelica deployments, customers have retired 12 separate tools and 5 point vendors after consolidating onto one shared record. That is the trade most buyers are actually weighing: more point tools, or fewer tabs and more work getting done.

The buyer is not asking for "more AI." The buyer is asking for "fewer tabs."

None of this makes analytics platforms wrong. If you have no unified data foundation, you may need one first. But if your teams already know what to do and the work is not getting done at volume, an execution layer is the higher-leverage purchase, and it deploys in weeks rather than quarters.

Sources and further reading

• Innovaccer: Galaxy launch announcement (Oct 2025)
• Arcadia: Healthcare BI data platform
• Navina: AI-powered risk adjustment
• Reveleer: Evidence Validation Engine (EVE)
• Pearl Health: Our technology
• Federal Register: CY2027 Medicare Advantage and Part D final rule (April 6, 2026)
• CMS Innovation Center: ACCESS Model
• NCQA: retiring the HEDIS hybrid method by MY 2029 and fully digital HEDIS by MY 2030
• NCQA: the digital quality transition (FHIR and CQL)
• Reveleer with Mathematica and Harris Poll: 2026 State of Technology in Value-Based Care
• Arcadia: healthcare AI survey of 281 leaders (June 16, 2026)
• Cotiviti: completion of the Edifecs acquisition (March 31, 2025)