Smarter Spending: Value-Based Purchasing under Managed Care
NC Medicaid will increasingly tie payment to value and will support PHP and provider contracting flexibility that helps providers deliver care in new ways. PHPs will play a critical role in driving forward Medicaid’s Value-Based Purchasing (VBP) goals.
The NC VBP strategy is built upon the HCP-LAN Framework.
Policy Papers for Public Comment
On January 8, 2020, the Department issued two policy papers for public comments detailing the strategy to promote value-based care in NC Medicaid Managed Care.
- North Carolina’s Value-Based Payment Strategy for Standard Plans and Providers in Medicaid Managed Care. This paper describes the vision for value-based payments (VBP) between Prepaid Health Plans and providers in NC Medicaid Managed Care.
- North Carolina’s Medicaid Accountable Care Organizations (ACOs) for Standard Plans and Providers: Building on the Advanced Medical Home Program to Drive Value-Based Payment. This paper provides details on an optional Medicaid ACO program, including ACO organizational requirements, payment parameters, total cost of care calculation and participation incentives for early adopters. PHPs and providers can form ACO arrangements as a way to promote value in Medicaid and meet the Department’s VBP targets.
Both policy papers can be found on NC Medicaid’s website.