Funder: United Hospital Fund

Author: Rob Houston, Katherine Heflin, and Tricia McGinnis, Center for Health Care Strategies

November 2015 | Report


Across the country, states are seeking to transform how health care is paid for by shifting from a volume-centric to a value-based payment (VBP) mindset. In June 2015, New York State released A Path Toward Value-Based Payment: Roadmap for Medicaid Payment Reform, outlining ambitious statewide plans to move 80-90 percent of managed care payments to providers from fee-for-service to VBP by 2020.

Navigating the New York State Value-Based Payment Roadmap — prepared by the Center for Health Care Strategies for the Medicaid Institute at the United Hospital Fund — outlines New York’s plans to transform how it finances health care services. The state intends to leverage existing efforts to realign payment and delivery, including the Delivery System Reform Incentive Payment (DSRIP) program and the State Innovation Model (SIM) initiative. The report describes New York’s VBP goals and walks through the state’s strategy to help providers shift toward new payment models. It also presents key questions to help guide the continued “evolution” of New York’s Roadmap for Medicaid Payment Reform and provides a helpful VBP glossary.

“In interviews we conducted and other discussions we’ve had with stakeholders in virtually every setting, we’ve heard repeatedly that the roadmap’s concepts were complex and difficult for even the most knowledgeable to get their arms around,” said Chad Shearer, director of the Medicaid Institute at United Hospital Fund. “We hope our new guide will help health care providers, health plans, and many others to understand the key takeaways that allow them to move forward in their organizational planning.”

Although developed for New York State, this report can help additional states in establishing comprehensive approaches to steer value-based payment and can also inform providers and stakeholders in preparing for the transition from fee-for-service to value-based purchasing.