Value-based care programs are flourishing across the U.S., with a seven-fold increase in the number of states implementing such initiatives in the past five years, according to a new Change Healthcare report. The report, Value-Based Care in America: State-by-State is the second national study of state healthcare payment programs that reveal 48 states have now implemented value-based care or payment programs, 50% of those programs are multi-payer in scope, and just four states have little or no value-based care initiatives underway.
Defining Value-based Payments
The report defines the term “value-based payments” full continuum of evolving payment arrangements that payers and providers are using as they move away from fee-for-service to payments that hold providers accountable for quality, outcomes, and total cost of care.
State Leading the Transition
The study highlights six states with well-developed value-based care strategies in place four years or more, 34 with initiatives two or more years into implementation, and eight states in early stage VBC development. Other noteworthy findings: Accountable Care Organizations (ACOs) and ACO-like entities are in place or considered in 22 states, and 16 states established or are planning bundled-payment programs. Three states—New York, Pennsylvania, and Vermont—are noteworthy for the broad scope of their breadth of initiatives, embrace of payment models that involve shared risk, and willingness to test innovative strategies.
Value-based Care in America: A Table View of State-by-State Initiatives
Value-Based Care in America: State-by-State provides a detailed accounting of the value-based and alternative payment landscape in all 50 U.S. states, Puerto Rico, and the District of Columbia. The report findings reflect the variety of innovative value-based care approaches deployed across the U.S. and highlight variation in sophistication, leadership commitment, and resources devoted to the national transition from volume (fee-for-service) to value.
See full state-by-state table below for details:
Why It Matters
“Much of the public’s attention is focused on the federal government’s role in catalyzing healthcare payment reform, but the significant work being done at the state level is no less important and meaningful,” said Carolyn Wukitch, senior vice president & general manager, Network and Financial Management, Change Healthcare. “Based on the report, it’s obvious that managed Medicaid programs are actively exploring numerous VBP models, and that states implementing more advanced strategies around healthcare payment transformation will ultimately drive the commercial markets.”
This report is based on an extensive analysis of publicly available information compiled in 2017 and updated in February 2019, with a focus on statewide value-based care and payment programs. This report highlights all U.S. states and includes the District of Columbia and Puerto Rico.
The study relies on information gleaned from primary sources, including state resources, federal government resources, and contractors that participate in state-initiated VBP programs. In addition, data available from secondary sources, including research reports from healthcare industry analysts; mainstream, business, and trade media; think tanks, public policy institutes, and research institutes; and other public sources were reviewed.
The research did not include independent verification of publicly available information in the form of interviews with government officials.