Value-Based Purchasing (VBP)

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Our goal of building a value-based purchasing (VBP) model is to improve quality and health for our members and lower cost.

 

Traditional Fee-for-Service

  • Payment is to provide more services
  • Payment is not based on quality, efficiency, or patient outcomes

 

Value-Based Purchasing

  • Change how you pay through different payment methods
  • Change what you pay for based on quality, efficiency, and patient outcomes
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Program Strategy

Our program strategy consists of four components:

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Our Program Strategy includes Healthier Populations by improving the health status of North Dakotans by promoting healthy lifestyles, preventive care, disease management, and disparity elimination, Better Outcomes by improving access to quality healthcare at an affordable price to improve outcomes, Better Experience by enhancing member and provider performance and Smarter Spending by increasing effectiveness and efficiency in the delivery of healthcare programs and ensure value in healthcare contracts.

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Program Overview

Program Start Date: July 1st, 2023

6 Prospective Payment System (PPS) Health Systems are mandatory participants in the model: Sanford Bismarck, Sanford Fargo, Altru Health System, CHI St. Alexius, Essentia Health and Trinity Health.

ND map with icons PPS hospitals in Bismarck, Fargo, Grand Forks and Minot

The PPS Hospital System VBP Program puts a portion of hospital payments at risk for performance on a suite of quality measures for their ND Medicaid patient population.

PPS Hospital Systems will see no loss of funding if they meet specific success criteria.

 

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Quality Performance

Within the VBP Program, there are five priority health care domains included to improve population health. All measures selected align to these domain areas.

  • Primary Care Access and Preventive Care
  • Maternal Health Services
  • Behavioral Health Services
  • Care of Acute and Chronic Conditions
  • Oral Health Services

The Quality Performance for each program year is outlined below:

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2026
Pay for Performance
Initial Measure Set
Well-Child Visits First 30 Months of Life
Child & Adolescent Well-Care Visit
Breast Cancer Screening
Postpartum Care: Prenatal & Postpartum Care
Screening for Depression & Documented Follow-up Plan
Ambulatory Care Emergency Department (ED) Visits
Plan All-Cause Readmissions
Topical Fluoride for Children
Expanded Measure Set
Colorectal Cancer Screening
Controlling High Blood Pressure

Maternal Health Services Optional Measures:

(systems must select 1)

  1. Prenatal Care: Prenatal & Postpartum Care
  2. Contraceptive Care: Postpartum Women
  3. Structural Measure: Perinatal Collaborative Participation

Behavioral Health Services Optional Measures:

(systems must select 1)

  1. Follow-up After Emergency Department Visit for Alcohol & Other Drug Abuse or Dependence
  2. Initiation & Engagement of Alcohol & Other Drug Abuse or Dependence Treatment
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Starting in 2025, Health system performance will be evaluated against the Statewide Target as well as their own historical performance. The Statewide Target is defined as the highest level of performance that the Department wishes to achieve across the state in order to provide high quality care to all North Dakotans. Statewide Targets will be selected for each measure except structural measures which will be rated as met/not met.

Statewide targets will be set based on availability and a reasonable, incremental rate of change according to the following hierarchy based:

  • Utilize the National HEDIS 50th percentile, or other applicable increment.
  • Utilize the National Adult or Child Core Median.
  • Utilize Regional data, as available.
  • Utilize State-selected Target or Improvement over self.
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Contact Information

Medical Services Division
North Dakota Health and Human Services 
600 E. Boulevard Ave., Dept. 325
Bismarck, ND 58505-0250

Email: dhsmedicaidquality@nd.gov