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
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| Value-Based Purchasing
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Program Strategy
Our program strategy consists of four components:
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.
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.
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:
Program Requirements |
| Care Delivery Inventory Tool Submission |
| VBP Outcomes & Insights Meeting Participation |
| Supplemental Data Submission |
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Pay for Performance |
| Breast Cancer Screening |
| Colorectal Cancer Screening |
| Child & Adolescent Well-Care Visit |
| Well-Child Visits First 30 Months of Life |
| Timeliness of Prenatal Care: Prenatal & Postpartum Care |
| Postpartum Care: Prenatal & Postpartum Care |
| Controlling High Blood Pressure |
| Plan All-Cause Readmissions |
| Topical Fluoride for Children |
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Provisional Measures* No at-risk funds allotted |
| Postpartum Depression Screening |
| Depression Screening and Follow-up (Adolescents and Adults) |
| Glycemic Status Assessment for Patients with Diabetes |
Pay for Reporting |
| Submit Quality Improvement Plans through VBP Reporting Tool |
| VBP Quality Improvement Outcomes Meeting |
| Supplemental Data Submission |
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Pay for Performance |
| Breast Cancer Screening |
| Child & Adolescent Well-Care Visit |
| Well-Child Visits First 30 Months of Life |
| Postpartum Care: Prenatal & Postpartum Care |
| Controlling High Blood Pressure |
| Plan All-Cause Readmissions |
| Topical Fluoride for Children |
| Screening for Depression & Documented Follow-up Plan |
| Ambulatory Care Emergency Department (ED) Visits |
Starting in 2025, health system performance will be checked in two ways: how they compare to the Statewide Target and how they compare to their own past results. The Statewide Target is the level of performance the Department wants all providers in North Dakota to reach so that people receive high‑quality care. A Statewide Target is set for every measure.
Statewide targets are set based on what data is available and what level of improvement is reasonable. The targets follow this order:
- Use the National HEDIS 50th percentile, or another similar benchmark.
- Use the National Adult or Child Core Median.
- Use regional data if it is available.
- Use a target chosen by the state or an improvement over the system’s own past performance.
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