Generating Evidence-Based Policy Options for Centering Community Member Perspectives in NC Medicaid VBP Design

Overview

Value-based payment (VBP) models have the potential to tailor health and social care to address Medicaid members’ unique needs through flexibilities granted to health care providers. However, VBP models were not historically designed the specific needs of vulnerable populations as a central goal and past research suggests that VBP could exacerbate existing disparities by “cherry-picking” healthier patients, concentrating models within higher-resourced communities, or systematizing bias and discrimination through specific VBP design choices. As part of NC Medicaid’s managed care transition, health plans will increasingly move provider contracts to VBP, creating an opportunity to build on real-world examples and thought leadership on embedding concepts of equity directly into VBP design elements.  

Through this research project, our goal is to develop evidence-based policy options for centering community member perspectives in NC Medicaid VBP design to reduce disparities in health and health outcomes. Through a mixed methods approach using community-engaged research strategies and Medicaid claims-based simulations of payment model components, we will elevate community perspectives in VBP design and examine how VBP design affects rural and historically marginalized populations, including populations with specific clinical needs. We will also develop practical options for centering community member voice in VBP design through an inclusive, multi-stakeholder process involving NC Medicaid, healthcare providers, health systems, insurers, consumer advocacy organizations, and community members. 

For more information about the purpose of our project, see our Community Brief.

Duke University Health System IRB Protocol Number: Pro00113093 

Funding 

Funding for this project is provided by the Kate B. Reynolds Charitable Trust.