Tuesday, March 1, 2016

Brief: How States are Shifting to Value-Based Payments Through Managed Care

Lilly Hummel

With support from CMS, the Center for Health Care Strategies (CHCS) released a brief last week that explored state options for using managed care contracts to accelerate provider adoption of value-based payment (VBP) arrangements. State Medicaid agencies have traditionally relied on contracted managed care organizations (MCOs) to independently oversee VBP arrangements that emphasize a shift away from fee-for-service payment that emphasizes volume towards a payment system that emphasizes quality and population health management.

Understanding the emphasis on provider adoption of VBP is critical because states are increasingly using managed care for their Medicaid population. States are now proactively leveraging MCO contracts to increase VBP participation, rather than waiting for MCOs to make payment changes.

CHCS identified 5 general approaches to VBP in MCO contracts:
  1. Require MCOs to adopt a standardized VBP model (examples: Minnesota, Tennessee);
  2. Require MCOs to make a specific percentage of provider payments through approved VBP arrangements (examples: Arizona, Pennsylvania, South Carolina);
  3. Require MCOs to move toward implementation of more sophisticated VBP approaches over the life of the contract (example: New York);
  4. Require MCOs to actively participate in a multi-payer VBP alignment initiative (example: Tennessee); and
  5. Require MCOs to launch VBP pilot projects subject to state approval (examples: New Mexico, Minnesota)
An increasing shift towards VBP and away from traditional fee-for-service payment could affect how MCOs contract with providers, including assisted living communities that offer home and community-based services.

No comments:

Post a Comment