Future of sustainable value-based care: Best practices for payment methods

Creating a Sustainable Future for Value-Based Care: A Playbook of Voluntary Best Practices for VBC Payment Arrangements (PDF) offers voluntary best practices for overcoming key challenges associated with underlying payment methodologies for value-based care (VBC) arrangements. It builds on prior work focused on improving the collection and bi-directional sharing of data within these arrangements, part of the “Future of Value” collaboration with AHIP and the National Association of ACOs (NAACOS) to advance sustainable VBC adoption.

Intended for both current and future participants, this playbook provides physicians, participating practices, VBC entities, health plans, purchasers and employers access to best practices for aligning payment with performance on quality, cost, and patient and physician experience. These economic incentives are intended to enable changes in care delivery to further evidence-based, preventative, equitable and coordinated whole-person care.

All the identified best practices were informed by real-world experiences of those currently participating in such arrangements. By exploring lessons learned from on-the-ground implementation, these voluntary best practices improve awareness of what works well alongside opportunities to further reduce unnecessary variation and administrative burden hindering sustainable participation moving forward.

Based on input from a multi-stakeholder workgroup, best practices are organized into seven key payment domains: 

1. Patient attribution: Correctly identify the patient population, and their associated medical costs, to be held accountable for during a performance period. 
2. Benchmarking: Establish a predictable, transparent and achievable financial target that rewards efficiency and improvement via the transformation of care activities.  
3. Risk adjustment: Accurately adjust payments in a clear and understandable way that reflects the intensity and acuity of the attributed patient population.
4. Quality performance & impact on payment: Incentivize quality improvement, sustain high-quality care and promote expanded patient access including for historically marginalized or clinically complex populations.
5. Levels of financial risk: Appropriately calibrate levels of risk based on level of readiness and what can be effectively managed via customizable payment options.
6. Payment timing & accuracy: How and when payments are distributed, taking into account personal needs and the larger overarching goals of the VBC arrangement.
7. Incentives for VBC practice participant performance: Consideration for if and how to engage each individual participant in connection with the overall success of the VBC arrangement.

Read more about these domains, including discussion of specific challenges and other additional considerations moving forward for the broader VBC landscape provided in the playbook (PDF).