MACPAC Meeting Recap: Value-Based Payments in Managed Care

Recently, I had the opportunity to present at the Medicaid and CHIP Payment and Access Commission's (MACPAC) monthly meeting and to participate in a panel discussion about the use of value-based payments in Medicaid managed care. Though the current COVID-19 pandemic has shifted the issues of focus within the health care system, decisions made today by providers will help inform what care will look like in a post-pandemic world and what value-based payment arrangements may look like in Medicaid in the future.

Along with Bryan Amick, deputy director for the Office of Health Programs, South Carolina Department of Health and Human Services, and Tom Mattingly, senior vice president of provider networks, CareSource, together we shared our reactions to the findings in a recent Baillit Health report on delivery system reform and talked about how value-based payment (VBP) models are working in practice in Medicaid. 

As part of state efforts to improve quality and reduce costs, many state Medicaid programs have begun shifting to VBP. In these models, quality outcomes are built into the contracts themselves. One of the key takeaways from our panel was the importance of creating partnerships with providers to achieve these quality goals. It’s vital that health plans and providers are moving in the same direction on how to improve outcomes for Medicaid members.

When it comes to forging these partnerships, it’s also important to reach a place where there’s a shared incentive for providers to participate. With this, it is critically important to understand that there are different levels of provider readiness for shifting to VBP. Not every provider is able to take on the risk, and certainly not in a short period of time. For example, providers in rural areas, or smaller provider practices, are often not in a position to do that. Creating thresholds to meet value can put health plans in a position of pushing providers away rather than bringing them in.

When we talk about supporting providers, we have to think about how we can create value and support them in this work in a meaningful way. Micro incentives can be one such support mechanism. For example, UnitedHealthcare Community & State is currently running a pilot program to help educate personal care attendants on their role in the early identification of health issues and risk for emergency services use. As these personal care attendants improve outcomes, the incentive comes to them individually, rather than to their agency. That one change, and similar initiatives like it, can create a foundational focus on quality that makes a positive impact across the entire health care ecosystem.

Health plans must also foster collective accountability with providers. This requires an ongoing conversation to make sure both of us are creating a model in which we can collectively be successful. We need to be flexible, and that means encouraging and rewarding active provider engagement.

By working together, we can better align incentives and identify opportunities for innovation in the Medicaid system. Most importantly, when health plans engage providers in a way that improves outcomes and meets VBP quality goals, those we have the honor to serve and care for achieve better health and well-being.

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