Maximizing Value in Wound Care: Providers Seek Innovative Solutions to Meet Value-Based Care Mandates

Reimbursement models such as bundled payments and capitated arrangements have become more common. Additionally, around 129 million people are now covered by Medicare and Medicaid. These programs have experienced significant changes in reimbursement, ranging from Value-Based Care (VBC) to Accountable Care Organizations (ACOs) to Alternative Payment Models
Why it Matters
Each model has different guidelines, regulations, reimbursement formulas, and penalties. This means virtually every task undertaken by wound care providers has been affected. For example, hospital readmissions, a critical issue for wound care, have been tied to significant financial penalties under the Hospital Readmissions Reduction Program (HRRP). At the same time, reductions in reimbursement rates for certain services, particularly in outpatient wound care, have squeezed profit margins. And that means we are all struggling to find innovative solutions to target critical areas.
Prepare for the Future
To adopt, more providers are exploring a number of options, from technology to new products to new staffing models. These represent massive changes.
“Twenty-five years ago, wound care depended on two core areas: dressings that protected the wound and antimicrobial creams/ointments to control infection and bacteria in the wound. That was essentially it… Looking ahead, patients will be well-served by progress in the portability, mobility and enhanced convenience of advanced wound care treatment modalities.” – John Harper, Ph.D., noted industry expert as quoted in The Alliance of Wound Care Stakeholders.
As an example of innovations in the field, there are now wound dressings that incorporate growth factors or biomaterials to promote tissue regeneration. When integrated into existing workflows, these products can reduce healing times and lower the risk of complications, leading to improved patient outcomes and reduced costs.
As reimbursement models evolve, robust and reliable wound care data is also becoming a crucial tool for providers. By understanding which treatments are most cost-effective and yield the best outcomes, providers can implement strategies that align with both clinical goals and the financial realities of value-based care. Embracing innovations supported by evidence-based research and clinical trials ensures that these strategies deliver measurable value.
Wound care leadership is essential to navigate the changing times and to ensure new models are economically viable for an organization. This involves analyzing outcome data, considering the potential impact on staffing, and evaluating the ease of integration into workflows. A strategic, data-driven approach to adopting new technologies can help ensure that innovations deliver on their promise to improve care while controlling costs.
As wound care providers continue to operate within an increasingly complex reimbursement environment, adopting advanced technologies and methodologies is crucial to success. By staying informed about the latest trends and focusing on evidence-based solutions, providers can maximize the value of their wound care programs, enhance patient outcomes, and thrive in the ever-shifting reimbursement landscape.
Connection to Net Health
To navigate this changing landscape, providers are turning to technologies like digital wound management platforms that incorporate AI to assess wounds and predict healing trajectories.
With technologies like Net Health® Tissue Analytics, patients can now receive wound assessments at home, reducing the need for in-person visits and allowing providers to catch complications early, thereby avoiding unnecessary hospitalizations. This shift toward remote and digital solutions is helping providers manage larger caseloads while maintaining the quality of care.
Advanced AI Used to Improve Treatment Planning and Streamline Billing

Artificial Intelligence is a buzzword in every industry in 2025, particularly for medical providers. Uses are rapidly evolving as the technology learns from expanded applications. AI can process large quantities of data quickly and cross-reference a set of data with what it has learned. This processing speed can benefit physical therapists and patients as the technology examines images and medical history to accurately predict healing, risk factors, root causes, and treatment plans. Rather than relying on one provider’s knowledge and experience, it can synthesize massive amounts of data to compare the patient to millions of other data points. This improves the accuracy of diagnosis and develops a more accurate treatment plan.
Why it matters
AI will continue to refine its suggestions for better, more effective treatment by adding data to the technology through documentation and measurement. Instead of following prescribed physical therapy programs, AI can help providers develop personalized treatment plans that consider a patient’s age, mobility, health history, and potential areas of concern. Customized plans will evolve as more information is gathered and the patient progresses through treatment and makes improvements. It can notice patterns, monitor trends, and predict needs quickly. Allowing AI to constantly iterate treatment plans in response to a patient’s progress leads to faster recovery times and more provider availability. This is particularly essential in rural or high-cost-of-living areas experiencing PT shortages.
An additional layer of support AI can offer is monitoring sessions with patients. AI can measure and track even minute changes in mobility, pain, angles, posture, and balance. Employing wearable technology or motion capture technology during physical therapy improves the experience and the accuracy of documentation and future planning. AI and robotic coaches can fill gaps in support for patients during therapy. It can interact with patients, keeping them on track between appointments by reminding them to practice exercises and correcting unhelpful movement patterns.1
AI also supports clinicians by completing paperwork, tracking documentation, and catching billing errors. Using AI to support clerical work will save the practice time and money. Integrated electronic medical records can proactively understand payer regulations and ensure compliance by alerting practices to errors. In a 2023 APTA study, three-quarters of providers reported that prior authorization requirements delayed treatment by more than 25%. Ten percent of claims are denied the first time they are processed, and most respondents report spending more than 30 minutes on each of these claims.2 Using AI to screen documentation for errors before submission will save time and money for all physical therapy practices.
While embracing AI to streamline administrative tasks and improve treatment is exciting, we can’t ignore that many people are still wary of this new technology, and it can pose privacy risks if not used correctly. When implementing AI technology into your practice, understand what it can and cannot do accurately. Carefully select your technology provider by screening their security, backup methods, and privacy regulations. Medical providers have access to large amounts of personal data and are responsible for protecting it, even if they use AI to support treatment and billing.
Prepare for the future
Be open to embracing the right AI technology for your practice. Identify areas where big data sets and natural language models will save time and make you more effective. Research the possibilities for AI to transform your billing systems and treatment planning.
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