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Payment Models

Evaluation and prioritization is required to determine the highest impact opportunities to pilot and test innovative new approaches to providing incentives internally and when care VA purchases care in the community. We are currently exploring 6 payment initiatives.

Episode-based Payment Initiatives

Health care providers in the choice program would be held accountable for the cost, outcomes and quality of care beneficiaries receive during an episode of care. Models under this initiative would be tested with both preventive and curative episodes with varying degrees of risk included to incentivize improved performance.

Subscription-based Payment Initiatives

Models under this initiative would test the effectiveness of pricing models and payment structures that allow VA to purchase services in the community or sell services across facilities or regions for a specific period of time for a set price. Subscribers typically commit to the services on a monthly, annual or biennial basis.

Individual and Team-Based Payment Initiatives

Models under this initiative would test the effectiveness of payment structures that permit the VA to provide individual and team-based incentives to motivate performance excellence. Individual incentives would reward outstanding individual performance regardless of team performance. Team-based incentives on the other hand would reward team excellence regardless of individual underperformance, incentivizing groups to work together for the benefit of the collective.

Shared Savings Payment Initiatives

Models under this initiative would test the effectiveness of payment structures that permit entities within the VA as well as community partners to receive a share of savings created to be repurposed at the discretion on the entities entitled to a share of the savings.

Direct Contracting Payment Initiatives

Models under this initiative would test the effectiveness of payment structures that permit the VA to purchase care directly from service providers in the community without utilizing any intermediaries.

Multi-Payer Payment Initiatives

Models under this initiative would test the effectiveness of integrating VA payments, and enabling infrastructure with other public and commercial payers.

Page last updated on March 27, 2019