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Hospital Care CDA

Hospital care CDA overview

A care delivery area (CDA) is an innovative value-based payment (VBP) arrangement. See the VBP Roadmap for Coordinated Care Organizations.

Hospital care is a significant portion of health care spending and a common location for Oregon Health Plan members to receive health care services. The hospital care CDA fosters innovative pilot VBP arrangements between CCOs and their contracted hospitals, including:

  • Inpatient hospital care, encompassing inpatient stays, surgeries, or other procedures rendered;
  • Outpatient hospital surgeries, including hospital-affiliated ambulatory surgical centers; and
  • Emergency departments.
The hospital care CDA is not meant to include outpatient clinics, such as primary care clinics, that are hospital owned or affiliated, or primary care services that are rendered in outpatient clinics but are billed through hospitals.

Oregon hospital care delivery area briefs


Association Between Federal Value-Based Incentive Programs and Health Care–Associated Infection Rates in Safety-Net and Non–Safety-Net Hospitals 
Hsu, HE et al. Journal of the American Medical Association Network Open, 2020;3[7]:e209700 

  • A study of the implementation of federal value-based incentive programs associated with disparities in health care–associated infection rates in 618 safety-net and non–safety-net hospitals in the US.
  • Key points: Implementation of federal value-based incentive programs was not associated with any improvements in targeted health care–associated infection rates or with changes in disparities in infection rates among safety-net and non–safety-net hospitals.

The Challenges of Hospital Contracting in the Era of Value-Based Purchasing 

  • Explores the challenges in hospital contracting based on some health plans' experiences.
  • Key points: The design and close monitoring of VBP is important to address unintended negative consequences for the healthcare systems and patients.

Hospital Value-Based Purchasing Program 
Center for Medicare and Medicaid Services (CMS)

  • Describes how CMS rewards acute care hospitals with incentive payments for quality of care provided in the inpatient hospital setting.
  • Key points: Information and links to the measures that hospitals are scored on for this CMS Medicare program.

Hospital Value-Based Purchasing Program 
CMS QIO Health Services Advisory Group

  • Provides more information about the CMS Hospital Value-Based Purchasing Program that links acute-care hospitals' payments to their performance on quality measures. 
  • Key points: Policy and technical guidance related to hospital VBP programs. Including tools and resources to help improve performance on VBP measures.

Oregon Value-Based Payment Compact: A statewide collaborative partnership for bending the cost curve 
Oregon Health Leadership Council

  • The October 2020 voluntary agreement signed by more than 40 health care organizations based in Oregon who are committing to advancing the adoption of value-based payment across the state.
  • Key points: A set of principles to increase the spread of VBP models across the state and the specified targets and timelines for the next four years.

Rural Hospital Toolkit for Transitioning to Value-based Systems 
National Rural Health Resource Center

  • Best practices for improving financial, operational and quality performance that position rural hospitals and networks for the future, as well as strategies for transitioning to value-based payment and population health.
  • Key points:
    • Best practice tools that improve financial performance, operational efficiencies, and quality of care and reporting.
    • Key strategies to help leaders position their organizations for value-based care and prepare for population health.

Seven Considerations in the Financial Modeling of Value-Based Payment Arrangements 
Healthcare Financial Management Association

  • Seven considerations for hospital and health care system finance leaders with a guide to determining whether the hospital’s financial model includes the key attributes and requirements to successfully manage a shift toward VBP.
  • Key points: Hospitals need to look across each VBP arrangement and model the impact, look at the expenses to enter and manage a value-based arrangement, and assess the potential impact on overall volumes, utilization and revenue outside the arrangement.

Transitioning Community Hospitals to Value-Based Care: Lessons From Massachusetts 
Louis, CJ. et al., The American Journal of Accountable Care, December 2017, Volume 5, Issue 4

  • Massachusetts Health Policy Commission’s Community Hospital Acceleration, Revitalization and Transformation (CHART) investment program is the state’s largest effort to date aimed at readying community hospitals for value-based care. This paper examines the first two phases of the CHART program.
  • Key points: Community hospitals experience narrower operating margins and more limited access to large populations than large or academic hospitals, making the shift to value-based care difficult. Report offers insights for other states contemplating innovative approaches to bolstering community hospital participation in value-based care models.

Uniquely Similar: New Results from Maryland's All-Payer Model and Paths Forward for Value-Based Care 
Milbank Memorial Fund Issue Brief

  • Discusses the 2019 final evaluation of Maryland's All-Payer Model, which established a global budget for hospitals with comparisons of other efforts across the nation.
  • Key points:
    • Nationwide, hospitals took similar steps and followed similar pathways as other organizations participating in a wide range of payment models
    • Successful participants have lowered costs by focusing on reducing avoidable hospital admissions, professional services, and post acute care utilization
    • Maryland’s approach offers one viable way to implement payment models — placing accountability on providers through a spending cap and requiring participation — but it is not the only way.

CMS Hospital Readmission Reduction Program
CMS Hospital-Acquired Condition (HAC) Reduction Program

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