A recent analysis by Guidehouse is indicative that more states in the U.S now require VBP contracts, value-based payment contracts between the providers, and Medicaid MCOs.
The shift from fee-for-service to VBP contracts has been going on for quite some time. However, the process can be pretty complex as the specifications regarding the VBP payments vary for different states.
For example, MCOs belonging to 29 states have to implement VBP contracts with providers as of now. Almost 26 states have specifically described VBP details that the states have to follow. Yet, the specifications and details vary considerably. Moreover, some of the states are yet to declare specific requirements that should be part of VBP payments. These are Kentucky, Illinois, and Georgia.
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Besides Washington, D.C, 36 states include the availability of Medicaid Managed Care.
The demand for VBP contracts or different payment options highlights the possible impacts on providers, MCOs, and states.
Here is an attempt to summarize the possible impacts of the shift to VBP contracts.
States with no experience in VBP may derive insights into its implementation from the states that have adopted it. The fundamental aspect of VBP payments is that there are no common strategies.
States that already have existing VBP contracts should monitor their effectiveness in health outcomes and value promotion.
New methods or metrics can be considered in the VBP implementation if needed.
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With respect to Medicaid MCOs, they will have to implement frameworks and VBP models that are easily deployed with the respective provider networks. MCOs need to develop VBP capabilities proactively.
It is beyond doubt that more states will be implementing VBP contracts in the upcoming years. And it makes it compulsory for MCOs to research and implement future-ready VBP capabilities proactively.
Providers should also introduce changes to their long-standing methods and be flexible enough to accept alternative payment options for their reimbursements.