Value-based payment resource library

Driving Health System Transformation - A Strategy for the CMS Innovation Center’s Second Decade
Centers for Medicare & Medicaid Services (CMS) white paper on the CMS Innovation Center Strategy Refresh

• Released October 20, 2021
• Key points: provides a comprehensive overview of lessons from the Innovation Center’s first decade, goals, and next steps in five identified strategic areas. It also shares new models or concepts that the Innovation Center is exploring.

Alternative Payment Model (APM) Framework White Paper 
Health Care Payment Learning and Action Network (LAN) 

• Originally published in 2016 and updated in 2017, the LAN's APM Framework established a common national approach and pathway for measuring successful payment models.
• Key points: Describes how LAN classifies APMs/VBP models in four categories and eight subcategories, specifying decision rules to standardize classification efforts.

Categorizing Value-based Payment Models According to the LAN Alternative Payment Model Framework: Examples of Payment Models by Category
State Health and Value Strategies/Bailit Health

• Examples of the types of payment models that fit within the LAN Framework categories.
• Key points: Examples of VBPs within each of the LAN categories from federal, other state and health plan programs.
  

Value-based Payment: Is It Disrupting Health Care for the Better? 
OHA and Health Management Associates

• This webinar focuses on the “why” of VBP for providers; how VBP contracting models can support providers’ efforts to improve the health outcomes of their patients; and how fee-for-service reimbursement limits patient access to care, self-management and accountability.
• Slides / Recording (3/15/21)

Value-Based Payment Technical Guide for Coordinated Care Organizations 
November 2021, Oregon Health Authority 

• Describes Oregon's VBP expectations under the recent Medicaid coordinated care organization (CCO) contracts (“CCO 2.0”) for 2020‒2024.
• Key points: OHA's VBP expectations and technical guidance.
  

What Do You Need to Know to Negotiate VBP Agreements? 
OHA and Health Management Associates

• This provider-focused webinar describes how to evaluate and negotiate VBP offers.
• Slides / Recording (4/21/21)

Risk stratification

A Practical Risk Stratification Approach for Implementing a Primary Care Chronic Disease Management Program in an Underserved Community
Junjun Xu et al., Journal of Health Care for the Poor and Underserved. 2018; 29[1]: 202-213

• Demonstrates an approach to risk stratification with a sample of patients in an urban academic family medicine clinic over two years.
• Key points: A simple risk stratification approach for identifying common conditions among high-risk patients.

Risk Stratification Action Guide 
National Association of Community Health Centers

• Developed as a resource for community health centers, this action guide discusses population health management and risk stratification.
• Key points: Risk stratification goals, with an outline of a stepwise process to categorize patients' risk level by number of clinical conditions.

Risk Stratification: A Two-Step Process for Identifying Your Sickest Patients 
Dera, J., Family Practice Management. 2019 May-June;26[3]:21-26

• This paper describes how a practice applied a structured approach to determine their patients' health risk levels and used it to improve their care teams' support for their patients.
• Key points: Risk stratification enabled the practice to provide risk-stratified care management. Article includes a risk stratification algorithm tool and considerations for workflow changes that improve care management.
  

Attribution

Patient Attribution: Why the Method Matters 
McCoy RG, et al., American Journal of Managed Care. 2018 Dec; 24[12]: 596-603

• This paper assesses the impact of five commonly used patient attribution methods for measuring health care cost, quality and utilization metrics within an integrated health care delivery system.
• Key points: Reliable identification of the physician-patient relationship through attribution is necessary for accurate evaluation of health care processes, efficiencies and outcomes.
  

Whose Patient Is It? Patient Attribution
Milliman Healthcare Reform Briefing Paper

• A classic paper by the Milliman actuarial firm that succinctly describes several attribution methods and considerations for their use.
• Key points: Summary of key attribution terms and methods for successful accountability models for VBP.
  

Evidence-based care and workflows

Explore proven ways to help practices successfully implement VBP agreements.

Improving Access to Care: Telemedicine Across Medical Domains
Barbosa, W. et al, Annual Review of Public Health, April 2021

• A review of the impact of telehealth on access to care and health outcomes for many conditions including stroke, heart disease and pregnancy. It also assesses how telehealth can improve care under VBP.
• Key points: For certain medical conditions, telemedicine has demonstrated improved health outcomes with associated reductions in cost. Telemedicine has improved prenatal access and outcomes as well as improved access for underserved patient populations, especially those residing in rural areas.

Value-Based Toolkit for Primary Care Providers
University of Washington

• This toolkit describes how to develop a practice strategy and operational transition plan to achieve success with a mix of fee- for-service and VBP contracts.
• Key points: Part 1 explains principles, approaches and tools that practices can use to improve total cost of care and quality. Part 2 offers a practice-specific analysis and decision-making process to develop an operational transition plan. Includes downloadable examples, tools, templates and guidelines to improve performance on VBP.
  

Performance measurement

Clinicians and system leaders will find tools here for understanding how to select metrics and benchmarks for VBP contracts.

Determining Performance Benchmarks for a Medicaid Value-Based Payment Program 

Medicaid Innovation Accelerator Program

• The article and slide deck provide several approaches for setting performance benchmarks for VBP in Medicaid.
• Key points: Consider including stakeholders in developing and setting benchmarks; choose the method for benchmarking that suits the context and goals for measurement; set benchmarks to motivate, not discourage improvement; allow opportunities for adjusting benchmarks over time

Measuring Success in Health Care Value-Based Purchasing Programs 
RAND Health Quarterly

• Reviews the published literature on value-based purchasing programs. It includes a discussion with an expert panel on several topics including benchmarks used by these programs.
• Key points: Three value-based purchasing models were the focus of the review: pay-for-performance programs, accountable care organizations, and bundled payment programs.
  

Tricky Problems with Small Numbers: Methodological Challenges and Possible Solutions for Measuring PCMH and ACO Performance 
McCall, N. and Peikes, D., Mathematica Policy Research

• Provides approaches to measuring performance accurately with small panel sizes and across small numbers of organizations.
• Key points: Concrete strategies and resources to address methodological challenges with small numbers when evaluating performance and applying financial incentives and disincentives.

Performance Benchmarks for VBP Models 
OHA and Health Management Associates

• This CCO-focused webinar discusses considerations for developing performance benchmarks for population-based and episode-based VBP models.
• Slides / Discussion guide / Recording (8/24/21)
  

Performance Measures Criteria
American Academy of Family Practice (AAFP) 

• Summarizes the AAFP principles and criteria for selecting performance measures in VBP.
• Key points: Performance measures may overlap with quality measures that accelerate internal clinical improvement.
  

Practice Facilitation Handbook: Module 7. Measuring and Benchmarking Clinical Performance 
Agency for Healthcare Research and Quality

• A short overview of how to measure and benchmark clinical performance. This is part of a tool kit for practices on performance measurement.
• Key points: High-level overview of selecting clinical performance measures and benchmarking.
  

Promoting health equity

These tools explore how to design VBP models that improve health equity and address social determinants of health.

Accelerating Health Equity by Measuring and Paying for Results 
Center on Health Equity Action for System Transformation at Families USA, March 2019

• Discusses what is needed for payment models to address health equity.
• Key points: Not measuring and paying for equity can be a missed opportunity to drive reductions in health disparities and can also risk worsening disparities.

Evidence-based Community Health Worker Program Addresses Unmet Social Needs and Generates Positive Return on Investment 
Kangovi, S et al., Health Affairs 39, No. 2 (2020)

• Presents a return-on-investment analysis of the Individualized Management for Patient-Centered Targets (IMPaCT), a standardized community health worker intervention that addresses unmet social needs for disadvantaged people.
• Key points: The study found that every dollar invested in the community health worker intervention would return $2.47 to an average Medicaid payer within the fiscal year.

How Community Health Workers and Promotores Can Support Individuals with Complex Needs amid Covid-19 
The Playbook: Better Care for People with Complex Needs

• Evidence-based and promising practices for caring for people with complex health and social needs. This slide deck provides an overview of the role of community health worker programs to address the impacts of COVID-19 and improve health equity.
• Key points: Examples of how value-based care has driven health systems to think about community-based strategies for care. Includes consideration of full integration of community health workers and other community-based organizations into networks to allow participation in a share of total cost of care savings and to function as partners in care.

The Path Forward for Mental Health and Substance Use – Health Equity for All Americans 
National Alliance for Healthcare Purchaser Coalitions

• Presents five evidence-based reforms to improve health equity with early detection and access to effective behavioral health care. It was developed by a large coalition of purchasers, provider groups and payers.
• Key points: Improve in-network access to behavioral health specialists; expand screening and testing for behavioral conditions; expand behavioral health integration into primary care; improve tele-behavioral health; and resolve legacy mental health parity issues.

The Role of Social Determinants of Health in Value-Based Payment Models: A Rural Perspective 
National Rural Health Resource Center

• Recorded webinar that highlights how some rural health providers are collaborating with community-based organizations to address social determinants of health (SDOH) needs that result in improved health outcomes, reduced costs and advancing health equity.
• Key points: Overview of SDOH and how they affect health and well-being in rural communities; examples of how rural health providers, together with community partners, are leveraging value-based payment models to address SDOH; and available resources to support rural health providers and community partners to effectively address SDOH.
  

Using VBP to Reduce Health Disparities 
Oregon Health Authority

• National expert Marshall Chin, MD, leads this recorded webinar to help CCOs and other health system partners apply lessons from care transformation and VBP models from systems throughout the U.S. to help reduce health disparities.
• Slides / Recording (3/17/21)
  

Emerging trends

After COVID-19, A Payment Policy Reboot: Three Lessons from the Pandemic on How to Improve Value-Based Payment 
Navathe, A. and Liao, JM, Health Affairs Blog, August 11, 2020

• This article addresses three areas of health care that have been impacted by COVID-19 and potential adaptations going forward to improve health care quality and value
• Key points: The pandemic has shown it is possible to 1) deliver cost-efficient, patient-centered care via widespread telemedicine use, 2) the health care system is capable of efficiently meeting patient's needs in the right setting, and 3) COVID-19 has starkly exposed how social determinants and structural racism plague our health care system and the need to refashion VBP to address disparities.

Eliminating Inequity in Health Care Demands Measurement in Real Time 
Rosenbaum, S., Milbank Quarterly

• Summary and discussion of the issues of addressing health inequity, including links to research studies.
• Key points: Discusses need for real-time information grounded in actual practice.

Learnings from COVID-19 and How They May Impact the Adoption of VBPs
OHA and Health Management Associates

• This provider-focused webinar examines the role of VBP during the pandemic and its evolving impact on patient care in the future.
• Slides / Recording (5/19/21)
  

Telemedicine: What should the Post Pandemic Regulatory and Payment Landscape Look Like? 
Mehrota, A. et al., Commonwealth Fund Issue Brief

• An issue brief examining the impact of telehealth policies due to the COVID-19 pandemic with recommendations for future telemedicine guidelines.
• Key points: The importance of monitoring telehealth regulations for VBP models that include telehealth approaches to enhance access to care. Telehealth payments should be limited to services for selected patient populations and health conditions, or to services from providers that are paid by VBP. This will encourage high-value use and discourage overuse
  

Care delivery area resources

• Hospital care
  
• Maternity care
• Behavioral health care
• Children's health care
• Oral health care