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You Get What You Pay for: Measuring Quality in Value-Based Payment for Children’s Health Care

  • By: United Hospital Fund
  • Date: June 2016
  • Priority Area: Advancing Primary Care
  • Type: Resources
  • Category: Report
  • Document: Download

Overview

This United Hospital Fund report, supported by NYSHealth, focuses on the quality measures to consider as part of value-based payment (VBP) arrangements for children’s health care in New York. Children’s health emphasizes prevention and long-range outcomes, with benefits often realized outside of the health care system. For a small number of children with intensive health care needs, VBP poses a risk. Furthermore, standards for high-quality care evolve as a child ages.

Will children’s health programs with a proven track record get overlooked and passed over in the VBP push, or could VBP increase resources for effective models? If major savings cannot be accrued in child health care, what quality measures should define the desired outcomes and what guardrails should be put in place? What can be learned from child-focused VBP arrangements in other states?

The report presents four central lessons for New York State to consider:

  • Having government and public programs, particularly Medicaid, continue to lead the development and use of children’s health quality measures;
  • Establishing a process that creates incentives to go beyond what is currently measured;
  • Ensuring that children with special needs receive high-quality care under a VBP arrangement; and
  • Encouraging providers of pediatric primary care to integrate or coordinate oral and behavioral health services and address social determinants of health.
     

The report also includes three case studies from Oregon, Ohio, and Colorado as examples of what other innovative payers and providers have used in their child-focused VBP arrangements.