Value-Based Purchasing Design And Effect: A Systematic Review And Analysis

Abstract

During the past two decades in the United States, all major payer types-commercial, Medicare, Medicaid, and multipayer coalitions-have introduced value-based purchasing (VBP) contracts to reward providers for improving health care quality while reducing spending. This systematic review qualitatively characterized the financial and nonfinancial features of VBP programs and examined how such features combine to create a level of program intensity that relates to desired quality and spending outcomes. Higher-intensity VBP programs are more frequently associated with desired quality processes, utilization measures, and spending reductions than lower-intensity programs. Thus, although there may be reasons for payers and providers to opt for lower-intensity programs (for example, to increase voluntary participation), these choices apparently have consequences for spending and quality outcomes.

Exhibit 1

Value-Based Purchasing (VBP) number of unique empirical evaluations and type of outcomes studied, by higher- and lower-intensity programs Source: Authors’ summary of our systematic review inclusions used to inform this paper (methodology and citations of included programs and manuscripts available in appendix). Note: Unique empirical evaluations sum to less than the total number of evaluations for spending and quality outcomes as a given study may evaluate both spending and quality. The median number of evaluations per program was 2. The mean and standard deviation were 3±2.3. The greatest number of evaluations for a single program was 10.

Exhibit 4

Value-Based Purchasing (VBP) outcome positivity by literature rigor and program intensity Source: Authors’ summary of qualitative analyses conducted after assessing each included manuscript for outcomes, significance, and directionality Note: The categories “All,” “Higher-intensity,” and “Lower-intensity” include all studies irrespective of rigor level