Value-Based Payment and Financial Simulations

For many states, a critical component of Medicaid delivery system reform is payment reform. Within the Medicaid IAP functional area of value-based payment and financial simulations, CMS seeks to offer targeted technical support and solutions to Medicaid agencies in building and strengthening their capacity as they design and implement Medicaid delivery system reforms.

Value-Based Payment and Financial Simulations Technical Support

The Medicaid IAP provides individualized technical support for states interested in designing, developing, or implementing Value-Based Payment approaches (i.e. payment models that range from rewarding for performance in FFS to capitation, including alternative payment models and comprehensive population-based payments). Further, if a state seeks to pursue a particular Value-Based Payment approach, IAP provides the state with support to conduct financial simulations and forecasts that analyze the financial impact of these payment and delivery strategies.

The content of one-on-one technical support delivery for selected states is refined based on selected states’ specific needs, but follows a menu-style approach where states identify the technical support that best meets their needs, such as:

  • Strategic design, drilling down into states' payment model goals, objectives, and technical support needs
  • Development of Value-Based Payment approaches in Medicaid
  • Implementation of agreed upon Value-Based Payment approaches in Medicaid
  • Assistance in developing financial simulations of state-developed Value-Based Payment approaches

Starting in July 2017 selected states Idaho, Illinois, Kentucky, Massachusetts, Minnesota, New Hampshire, New Jersey, Oregon, Virginia, and the District of Columbia participated in the support opportunity for a 12 month period.

National Dissemination

Additional information can be found in the Information Session Slides.

Children’s Oral Health Initiative Value-Based Payment Technical Support

There are pockets of innovation around the country where providers deliver dental care in ways that improve children’s oral health outcomes, yet provider payment does not always align with the care delivery approaches. The Medicaid IAP launched this technical support opportunity for state Medicaid/CHIP agencies to select, design, and test Value-Based Payment approaches that will sustain children’s oral health care delivery models that are showing results. This opportunity complements CMS’s existing children’s Oral Health Initiative (OHI), which aims to support children’s oral health by increasing the proportion of children receiving preventive dental services.

Selected states partner with an established care delivery model site in their state. The technical support process involves the steps outlined below with financial simulation support available throughout the process.

  1. Selecting a value-based payment approach based on the state’s children’s oral health value-based payment goals and objectives.
  2. Designing the children’s oral health value-based payment approach.
  3. Testing the selected children’s oral health value-based payment approach with the partner care delivery model site.

Starting in June 2017 selected states Michigan and New Hampshire and the District of Columbia participated in the support opportunity for a 24 month period.

National Dissemination

Additional information can be found in the Program Overview, Appendix, and Information Session Slides.

Maternal and Infant Health Initiative Value-Based Payment Technical Support

The Medicaid IAP launched this technical support opportunity for state Medicaid/CHIP agencies to select, design, and test Value-Based Payment approaches to sustain care delivery models that demonstrate improvement in maternal and infant health outcomes. The IAP opportunity complements CMS’s existing Maternal and Infant Health Initiative (MIHI), which works with states to explore program and policy opportunities to improve outcomes and reduce the cost of care for women and infants in Medicaid and CHIP.

States participating in the Medicaid IAP opportunity are required to partner with a provider group(s), organization, and/or collaborative in their state to select, design, and test value-based payment approaches that sustain care delivery models that the partner is already implementing. The care delivery models are expected to have demonstrated success in improving maternal and infant health. In addition to tying value-based payment to care delivery models, states may also choose to partner with the same provider group(s), organization, and/or collaborative in their state to select, design, and test a value-based payment approach related to improving maternal and infant health that is not associated with a particular care delivery model (e.g. blended payment rates to incentivize vaginal over elective cesarean delivery, non-payment policies, billable services for new providers, etc.).

The technical support available to selected states is likely to involve the steps outlined below with financial simulation support also available.

  1. Selecting a value-based payment approach based on the state’s maternal and infant health value-based payment goals and objectives.
  2. Designing the maternal and infant health value-based payment approach.
  3. Testing the selected maternal and infant health value-based payment approach in partnership with at least one provider group, organization, or collaborative.

Starting in June 2017 selected states Colorado, Maine, Mississippi, Nevada, and Oregon participated in the support opportunity for a 24 month period.

National Dissemination

Additional information can be found in the Information Session Slides.