Value-Based Purchasing

HealthCare.gov states: "Value-Based Purchasing (VBP) links provider payments to improved performance by health care providers; this form of payments holds health care providers accountable for both the cost, quantity, and quality of care they provide to beneficiaries. VBP also attempts to reduce inappropriate care and to identify and reward the best-performing health care providers".

VBP is seen as a strategy to improve quality and value of health care services an individual receives by ensuring Health Plans and providers are accountable for providing high-quality, high-value care that satisfies patient experience. VBP moves away from traditional fee-for-service payments by utilizing value-based payments, which are payment methods for providers that reward providers for  the quality  of health care rather than the volume or number of patients a provider sees. According to the RAND Corporation, "VBP thus refers to a broad set of performance-based payment strategies that link financial incentives to health care providers' performance on a set of defined measures in an effort to achieve better value. Both public and private payers are using VBP strategies in an effort to drive improvements in quality and to slow the growth in health care spending".

Sources: https://www.healthcare.gov/glossary/value-based-purchasing-vbp/ 

  https://www.hca.wa.gov/about-hca/value-based-purchasing-vbp 

  https://www.rand.org/pubs/periodicals/health-quarterly/issues/v4/n3/09.html 

RAND Corporation: Measuring Success in Health Care Value-Based Purchasing Programs. (2014): This report summarizes the current state of knowledge about VBP based on a review of the published literature, a review of publicly available documentation from VBP programs, and discussions with an expert panel composed of VBP program sponsors, health care providers and health systems, and academic researchers with VBP evaluation expertise. Full report and summary-only documents. 

Med-QUEST Division (MQD) & VBP

According to the Hawai'i Quality Strategy 2020: "MQD’s VBP Road Map lays out the way MQD will fundamentally change how health care is provided by implementing new models of care that drive toward population-based care. The goal is to improve the health of Medicaid beneficiaries by providing access to integrated physical and behavioral health care services in coordinated systems, with value-based payment structures. MQD hopes to enhance quality of care for beneficiaries for health care and behavioral health through a combination of pay for performance incentives and VBP. VBP arrangements may be used to incentivize providers to achieve quality goals".

According to the Ohana Nui Project Expansion (HOPE) Project: "Payment reform implementing VBP incentives whole-person care and quality; MQD undertakes to hold a provider or a managed care organization (MCO) accountable for both the costs and quality of care they provide or pay for with VBP. MQD plans to evolve current MCO value-based purchasing requirements to reflect the Health Care Payment Learning and Action Network APM Framework (see below embedded link), and require the MCOs to move toward more sophisticated VBP purchasing over the life of the contract with primary care providers, hospitals, specialist, LTSS providers, and other provider types".

Sources: https://medquest.hawaii.gov/en/resources/quality-strategy.html   http://www.hawaiipublichealth.org/resources/Documents/Hawaii-Medicaid-Ohana-Nui-Project-Expansion%2012.15.17%20.pdf 

Further insight into VBP blueprint to guide the development of innovations to meet MQD goals: State of Hawaii -Department of Human Services Med-QUEST Division. Hawai‘i Quality Strategy 2020. 

VBP Resources

• Centers for Medicare & Medicaid Services: Value-based programs

• Centers for Medicare & Medicaid Services: Hospital value-based purchasing program

• Washington State Health Care Authority: Value-Based Purchasing Road map Apple Health Index (2021 update)

• Medicaid 1115 Demonstrations: Advancing VBP in Medicaid Section 1115 Delivery System Reform Demonstrations (2020)