Overview
This section describes VBP models for specific care delivery areas. The
primary care VBP model was developed collaboratively by payers and providers in Oregon and is recommended by OHA. Information about developing VBPs in other care delivery areas, including a variety of local and national resources, are provided for your consideration. These resources are not intended to be exhaustive, and inclusion does not indicate endorsement by OHA. These resources fall into the following categories:
VBP model resources
Alternative Payment Models for Healthy Steps
Healthy Steps Zero to Three
- A framework for states, health plans, health systems and pediatric primary care providers developing a VBP model based on the Healthy Steps model.
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Key points: Healthy Steps is a population-based, risk-stratified model that helps to operationalize and enhance the American Academy of Pediatrics Bright Futures recommendations.
Alternative Payment Models to Support Child Health & Development: How to Design and Implement New Models
Duke University, Margolis Center for Health Policy
- Outlines a series of considerations organizations should include in implementing VBPs for children's health and development.
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Key points: Identifies opportunities to encourage coordination across health care and social services and identifies opportunities to provide greater local flexibility for child-focused VBPs.
Payment for Progress: Investing to Catalyze Child and Family Well-Being Using Personalized and Integrated Strategies to Address Social and Emotional Determinants of Health
The Child and Adolescent Health Measurement Initiative/Academy Health
- Strategies and recommendations on VBP payment approaches and policies to promote positive social and emotional determinants of health and address risks like adverse childhood experiences and the stress and trauma that can result from adverse family and community experiences.
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Key points:
- Payments to improve child and family well-being
- Support enhanced and personalized well-child care
- Build sustainable capacity for transformation
Pediatric Value-Base Care Models
Moving Health Care Upstream Initiative Issue Briefs
- Nemours Children's Health System and the Duke-Margolis Center for Health Policy partnered on issue briefs that provide recommendations on pediatric VBP and integrated care models that address social drivers and promote health equity.
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Key points: Emerging examples of pediatric VBP with recommendations.
Value-based Payment Models for Medicaid Child Health Services
Bailit Health
- Supported by New York's United Hospital Fund, this report proposes a child-centered approach to value-based payment in Medicaid based on review of children's services, literature on children's health and health care, and expert interviews.
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Key points:
- Differences in children's health care utilization compared to adults and the value of children's health point to a different approach to VBP.
- Payment models need to address screening and effective interventions to address psychosocial risks and socioeconomic risk and consider approaches that address parental health and well-being.
- Separate payment strategies are needed for very high-need children where service needs generate high costs and are generally addressed by specialists.
- The value for children is unlikely to generate short-term savings and may require an upward adjustment in capitated payments for primary care.
Value-based Payment to Support Children's Health and Wellness: Shifting the Focus from Short-term to Life Course Impact
Center for Health Care Strategies
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Key points: Examples of Medicaid VBP models serving children, key themes, and policy considerations to help Massachusetts better meet children's needs. The lessons can inform payers and providers in other states.
Alternative Payment Models in Dentistry - A Provider Perspective
CareQuest Institute for Oral Health
- A 2021 report based on findings from a survey of 2,757 dental providers in more than 20 states.
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Key points: Survey findings suggest a need for provider awareness and education about alternative payment models and that COVID-19 has created opportunities to advance alternative payment models within the oral health care system.
Moving Toward Value-Based Payment in Oral Health Care
Center for Health Care Strategies, February 2021
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Key points: This brief, produced with support from the DentaQuest Partnership for Oral Health Advancement, summarizes oral health VBP models, examines challenges and opportunities, and provides considerations for expanding VBP in oral health.
Texas Improves Access to Routine Oral Health Services for Very Young Children
National Academy of State Health Policy
- An overview of how Texas included the dental home model into their Medicaid program with VBP payment approaches.
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Key points: Texas's First Dental Home and its enhanced bundled payment has increased access to preventive dental service and improved the oral health of Medicaid-enrolled children ages 6 to 35 months.
Value-based Care
CareQuest Institute for Oral Health
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Key points: The nonprofit CareQuest Institute for Oral Health provides education and resources including a tool for measuring organizations' readiness for VBP.
Value-Based Payment and Contracting Approaches for Caries Management: Implications for State Medicaid Programs
Medicaid Innovation Accelerator Program Children's Oral Health Initiative
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Key points: Provides brief descriptions of relevant oral health VBP articles and tool kits
Engaging Hospitals in Value-based Payment: CCO Success Cases
Center for Health Systems Effectiveness, January 2023
Hospital Value-Based Purchasing ProgramCenter 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.
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Key points: Information and links to the measures that hospitals are scored on for this CMS Medicare program
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.
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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.
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.
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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
CCO VBP Workgroup: Maternity episodes
VBP and Maternity Care: What Have We Learned So Far?
OHA and Health Management Associates
- This provider-focused webinar reviews emerging models of maternity care to address SDOH and racial disparities and the VBP reform efforts to support them. The webinar includes approaches that have been implemented in Oregon and nationally, and their outcomes, challenges and lessons learned.
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Slides / Recording (6/16/21)
Maternity Care Value Based Payment Arrangement
New York Department of Health
- An overview of NY State's Medicaid maternity VBP arrangement.
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Key points: Maternity VBP example that includes components of care, the underlying episodes of care, and the categories of measures recommended for New York State.
Maternity Episode Payment Models
Health Care Payment Learning and Action Network
- Examples of several states' approaches to maternity care VBP models.
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Key points: Ohio and Tennessee VBP frameworks, including key considerations and challenges.
Project Nurture Integrates Care And Services To Improve Outcomes For Opioid-Dependent Mothers And Their Children
McConnell, J et al., Health Affairs Vol 39. No. 4
- This study assesses the impact of Project Nurture on a range of patient and child welfare outcomes.
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Key points: Project Nurture was associated with reductions in child maltreatment, placement in foster care, and increases in both prenatal visits and maternal lengths of stay in the hospital.
Strong Start for Mothers and Newborns Evaluation: Year 5 Project Synthesis
Center for Medicare and Medicaid Innovation
- Summarizes the Strong Start Enhanced Prenatal Care Model Program, a CMS innovation project to test models of prenatal care. It includes final project synthesis and evaluation results.
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Key points: Three models of care were tested during the five-year initiative with dramatic reduction of preterm, low birth weight, and caesarean births for women who participated in birth center care compared with women of similar risk levels in usual care.
Learn more
Learn more about VBP terms by looking at descriptions in the
Glossary and consider recommendations throughout the toolkit related to educating your team on VBP terms and models and assessing internal interest and understanding of VBP as initial steps in assessing your readiness for a new or modified VBP model.