VALUE-BASED PAYMENT MODELS

Medicare Medicaid Alignment Initiative
Value-based payment structures are gaining popularity for many reasons.

1. Financial incentives can be designed to reward behavior and promote practice changes
   needed to successfully implement more efficient and effective models of care.
2. Financial incentives can help providers pay for investments in technology, process
   improvements, staff training, and culture changes needed for practice transformation.
3. Value-based payment promotes the delivery of the right care in the most timely and cost-effective setting. Patient portals, secure email, and nurse triage can be deployed without a
   negative impact on the provider’s revenue. Routine care issues that may not require an
   exam can be handled more quickly and conveniently for the patients, and early intervention
   may prevent a costlier level of visits or an adverse event.
4. The use of alternative members of the care team becomes practical. In many instances,
   nurses, medical assistants, pharmacists, dieticians, patient navigators, and others can
   deliver certain types of care or assistance more efficiently and effectively.
5. Providers are remunerated based on the value they produce, even if the volume of services
   is reduced.

Cost savings can be shared with nursing homes, behavioral health providers, specialists, hospitals, home and community-based providers, and others who are creating value for the beneficiary and the system as a whole.

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The model can align incentives to encourage disparate providers to collaborate to achieve objectives. Cost savings can be shared with nursing homes, behavioral health providers, specialists, hospitals, home and community-based providers, and others who are creating value for the beneficiary and the system as a whole. A well-structured model draws attention to the full continuum of healthcare services including long-term services and supports (LTSS) and behavioral health services, which have traditionally been of little interest to providers not directly involved in providing these services. Coordinating the full range of services is a key focus for CMS’ Medicare Medicaid Alignment Initiative (MMAI). High-cost, complex dually eligible individuals have historically suffered suboptimal outcomes because of inadequate coordination among primary care, LTSS, and hospital providers. MMAI creates the imperative for better rationalization of these services and improved handoffs as members transition from one type of provider to the next.