Considerations for a National Risk-Adjustment Model for Medicaid Managed Long-Term Services and Supports Programs

This brief examines considerations in developing a nationally available risk-adjustment model for MLTSS programs. It also explores research needed to develop a robust model that predicts expected LTSS costs as accurately as possible.

Rewarding High Quality: Practical Models for Value-Based Physician Payment

In Alliance of Community Health Plans’ newest brief, Rewarding High Quality: Practical Models for Value-Based Physician Payment; they examine how ACHP members across the U.S. have launched a diverse range of initiatives to reduce costs while increasing quality of care.

White Paper: Payment to Promote Sustainability of Care Management Models for High-Cost, High-Need Patients

This paper, by the Health Care Transformation Taskforce, illustrates Task Force members’ important investments in care management infrastructure and their success with improving outcomes for high-need patients under a patchwork of payment arrangements.

Key Payer and Provider Operational Steps for Successfully Implementing Bundled Payment

This brief from the Health Care Incentives Improvement Institute provides a more in-depth review of the operational steps health plans and providers are taking to be successful under bundled payment. The findings are based on interviews with seven payers, seven providers, and one organization selected as a convener.

Aligning Higher Performance Through Shared Savings Programs

Commissioned by The Center for Care Innovations, this discussion paper focuses on shared savings programs including where providers share in upside risk or where they share in both upside and downside risk as participants in Medicaid managed care programs.

Transitioning to Episode-Based Payment

This policy brief describes how to define an episode payment and how to transition to episode payment.

Oregon’s Bridge to Value-Based Payments for Community Health Centers: A Win for Medicaid, Providers, & Patients

This article summarizes a successful attempt to embrace value-based payment in Oregon health centers. The resource highlights risk-adjustment considerations for successfully implementing an alternative payment model.

Risk Adjustment for Sociodemographic Factors

This report provides a set of recommendations for successfully including socioeconomic status, race, ethnicity and other factors in risk adjustment. The National Quality Forum developed ten specific recommendations for health care organizations to follow through an expert panel of clinicians, academics, and public health professionals.

Sociodemographic Factors Affect Health Outcomes

This is a periodically updated list of evidence and resources on the need to risk adjust performance measures prepared by America’s Essential Hospital.

Impact of Risk Adjustment for Socioeconomic Status on Risk-adjusted Surgical Readmission Rates

This scholarly article explores whether differences in surgical readmission rates in safety net hospitals vs. non-safety net hospitals are the result of care quality differences. The study results indicate that variation in readmission rates are the result of differences in patient populations and not quality. The article suggests that risk adjusting readmission measures led to changes in hospital rankings.