Paying for Value in Health Care
Paying for value is a primary strategy for achieving the Oregon Health Authority’s triple aim of better health, better care and lower costs for all Oregonians. Meeting this goal will require shifting health care reimbursement strategies away from a system that pays for volume of services to one that rewards quality and outcomes.
The Health Authority is engaged in significant value-based payment (VBP) work across the agency. The Transformation Center serves as a focal point for value-based payment strategies and works closely with Oregon’s coordinated care organizations.
Value-based Payment Roadmap
Oregon has a long history of health system transformation, including efforts to move away from traditional volume-based health care payments to payments based on value that support positive member health outcomes and cost savings. Movement toward value-based payment (VBP) is supported nationally, as it is broadly accepted that the status quo fee-for-service payment model promotes a fragmented health system unable to provide patient-centered, whole-person care.
OHA recently completed a significant public engagement process to gather input from providers and key stakeholders on VBP, including statewide, multilingual public meetings and surveys, VBP-focused work groups with existing CCOs, and a survey of providers. The public engagement and stakeholder feedback gathered through this process, the Evaluation of Oregon’s 2012-2017 Medicaid Waiver, and the environmental scan of other states’ VBP policies informed OHA’s Value-based Payment Roadmap for Coordinated Care Organizations. They also informed the technical guidance companion report, OHA VBP Technical Guide for Coordinated Care Organizations (available by October 2019), previously referred to as Value-based Payment Roadmap: Categorization Guidance for Coordinated Care Organizations. These reports detail CCO 2.0 VBP requirements and processes, which begin in 2020.
As part of the VBP Roadmap public input process detailed above, the Transformation Center:
The Transformation Center also engaged stakeholders through the public meetings and surveys below.
Value-based payment stakeholder engagement (2018)
General CCO 2.0 stakeholder engagement (2018)
Primary Care Payment Reform Collaborative
As initiated through Senate Bill 231, the Transformation Center coordinates a Primary Care Payment Reform Collaborative. This collaborative convenes payers to share best practices on primary care value-based payment methods and aligning initiatives.
Comprehensive Primary Care Plus (CPC+)
Following Oregon’s selection as a CPC+ region, the center began supporting the Medicaid fee-for-service CPC+ implementation. CPC+ is a regionally based, multi-payer advanced medical home model offering an innovative payment structure to improve health care quality and delivery. It is a five-year federal program that began in January 2017 and will bring significant Medicare dollars to Oregon.