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.
Guidance and Resources
- VBP Guidance - This guidance provides details on year 1 and 2 PHP VBP expectations and targets. Attachments A and B below accompany this guidance. A longer-term VBP roadmap is in development.
- Attachment A: VBP Assessment - This is a retrospective reporting tool that PHPs must complete and submit to the Department annually documenting VBP contracts in place and payments made under VBP arrangements during the relevant reporting period.
- Attachment B: Templates for PHP VBP Strategy - These templates project VBP contracts and payments expected to be made under VBP arrangements in the coming year. These templates should be included in PHPs' VBP Strategies submitted to the Department annually.
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.