Evaluating Value-Based Payments in Primary Care

April 15, 2021

Physician, child and mom talking

In partnership with Care Oregon, the Center for Outcomes Research & Education (CORE) will study the impacts of primary care Value-Based Payment (VBP) model on cost and quality.

U.S. health care costs rank among the highest in the world. However, despite spending more than other countries, we are not achieving comparable results. Variations in quality and outcomes persist across demographic groups and geographic areas, as well as between providers and health plans. In response, plans and other health care payers are exploring the impact of Value-Based Payments (VBPs), an approach that incentivizes cost-effective and high-quality care rather than simply paying providers for the volume of services provided.

Yet evidence for VBPs’ impacts on costs and outcomes is mixed, particularly for primary care. In partnership with nonprofit health insurer Care Oregon with funding from The Patrick and Catherine Weldon Donaghue Medical Research Foundation, CORE will evaluate the impact of a primary care VBP model (Primary Care Payment Model, or PCPM) on cost and quality across 130 Oregon clinics. The clinics serve Medicaid and Medicare enrollees, including dual eligibles, in both rural and urban areas.  

This research will address three key questions:

  • How has the model affected health care cost and quality at participating clinics?
  • To what extent has this model’s impacts spilled over on cost and quality of care for clinic patients with sources of coverage other than CareOregon?
  • How do clinics’ experiences with the model – including their level of performance or earnings – influence their interest in and readiness for more advanced VBPs?

“Controlling cost and improving quality are essential to improving health and health equity in communities around the U.S.,” said Hannah Cohen-Cline, Program Director, Research & Evaluation at CORE. “This project will promote greater value in health care by providing evidence about how and for whom VBPs in primary care might help meet those goals.”

Additional focus areas include understanding how VBP models can drive system changes in clinics and how those changes may alter outcomes for populations who are not part of the VBP. The results will help set best practices for scaling and spreading VBPs. Finally, by evaluating a VBP model implemented in many clinics across different geographic regions this study has the potential to inform decisions by other payers and in other states about how to shape future primary care VBPs.

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