Generating Evidence-Based Recommendations for Centering Equity in North Carolina Medicaid Value-Based Payment Design

Overview

Value-based payment (VBP) models can improve health equity through flexibilities like tailoring healthcare delivery to the needs of patients and families and paying for social needs or disparity reduction. However, VBP models were not historically designed with equity 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 recommendations for centering equity in NC Medicaid VBP design to reduce racial and ethnic inequities 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 recommendations for centering equity in VBP design through an inclusive, multi-stakeholder process involving NC Medicaid, healthcare providers, health systems, insurers, consumer advocacy organizations, and community members.

Funding

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

Research Approach

Community Engagement: We will explore stakeholders’ biggest concerns in the transition to value-based care to inform our research approach and solicit feedback on priority populations and priority areas for simulation models through community-engaged research strategies (e.g., interviews, convenings).

Beneficiary Focus Groups: Through six in-person focus groups hosted within NC’s Medicaid Managed Care regions, we will engage beneficiaries and caregivers on topics including how beneficiaries and caregivers define high-quality healthcare and what they want their providers and health plans to be evaluated on for VBP contracts.

Quantitative Analysis: We will leverage 2019-2022 Medicaid claims to simulate payment model designs and examine the impact on priority populations identified through formative community engagement.

Synthesis & Policy Convening: We will synthesize and translate qualitative and quantitative findings into potential strategies for centering equity in VBP model design and implementation through a summative, multi-stakeholder convening.

Dissemination: We will disseminate our research findings and policy options through a variety of mechanisms including: research papers, fact sheets, explainer videos, and presentations to research, policy, and community audiences to create opportunities for advocacy and policy change.