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.

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

Funding 

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