Duke-Margolis Institute for Health Policy, Duke University.
Gillings School of Global Public Health, University of North Carolina.
Milbank Q. 2024 Sep;102(3):713-731. doi: 10.1111/1468-0009.12703. Epub 2024 Jun 7.
Policy Points State Medicaid experience with value-based payment (VBP) arrangements for medical products is still relatively limited, and states face a number of challenges in designing and implementing such arrangements, particularly because of the resource-intensive nature of arrangements and data needed to support measurement of desired outcomes. A number of success factors and opportunities to support VBP arrangement efforts were identified through this study, including leveraging established venues or processes for collaboration with manufacturers, engaging external and internal partners in VBP efforts to bolster capabilities, acquiring access to new data sources, and utilizing annual renegotiation of contracts to allow for adjustments.
To date, uptake of value-based payment (VBP) arrangements for medical products and knowledge of their design and impact have been mainly concentrated among private payers. Interest and activity are expanding to Medicaid; however, their experiences and approaches to VBP arrangements for medical products are not well characterized.
This study sought to characterize the use of VBP arrangements for medical products among state Medicaid agencies through the use of a two-staged, mixed-methods approach. A survey and semistructured interviews were conducted to gain an understanding of state experiences with VBP arrangements for medical products. The survey and interviews were directed at senior leaders from nine states through the survey, with respondents from seven of these states additionally participating in the semistructured interviews.
Although experience with VBP arrangements for medical products among states varied, there were similarities across their motivations and general processes or phases employed in their design and implementation. States collectively identified a number of significant challenges to VBP arrangements, such as manufacturer engagement, outcomes measurement, and the time, expertise, and resources required to design and implement them. We outline a range of strategies to help address these gaps and make it easier for states to pursue VBP arrangements, including more direct engagement from the Center for Medicare and Medicaid Services, state-to-state peer learning and collaboration, data infrastructure and sharing, and additional research to inform fit-for-purpose VBP arrangement approaches.
Findings from this study suggest that it may be easier for states to pursue VBP arrangements for medical products if there is greater clarity on processes employed that support design and implementation as well as effective strategies to address common challenges associated with contract negotiations. As states gain more experience, it will be important to monitor the design and implementation of common VBP arrangements to assess impact on the Medicaid program and the populations it serves.
政策要点 国家医疗补助计划（Medicaid）在医疗产品的基于价值的支付（VBP）安排方面的经验仍然相对有限，各州在设计和实施此类安排方面面临着许多挑战，特别是因为安排的资源密集型性质和支持所需结果衡量所需的数据。通过这项研究确定了一些支持 VBP 安排工作的成功因素和机会，包括利用与制造商合作的既定场所或流程，在 VBP 工作中利用外部和内部合作伙伴来增强能力，获取新数据源的访问权限，并利用年度合同重新谈判来进行调整。
迄今为止，基于价值的支付（VBP）安排在医疗产品方面的采用以及对其设计和影响的了解主要集中在私人支付者中。利益和活动正在扩展到医疗补助计划；然而，他们在医疗产品的 VBP 安排方面的经验和方法还没有得到很好的描述。
本研究通过使用两阶段混合方法，来描述州医疗补助计划机构对医疗产品的 VBP 安排的使用情况。通过调查和半结构化访谈，了解各州在医疗产品 VBP 安排方面的经验。调查和访谈针对九个州的高级领导进行，其中七个州的受访者还参加了半结构化访谈。
尽管各州在医疗产品的 VBP 安排方面的经验各不相同，但在设计和实施过程中，他们的动机和一般流程或阶段存在相似之处。各州共同确定了 VBP 安排面临的一些重大挑战，例如制造商参与、结果衡量以及设计和实施所需的时间、专业知识和资源。我们概述了一系列策略，以帮助解决这些差距，并使各州更容易追求 VBP 安排，包括医疗保险和医疗补助服务中心（CMS）更直接的参与、州与州之间的同行学习和合作、数据基础设施和共享，以及更多的研究来为适合目的的 VBP 安排方法提供信息。
这项研究的结果表明，如果在支持设计和实施的过程以及解决与合同谈判相关的常见挑战的有效策略方面有更清晰的认识，各州可能更容易追求医疗产品的 VBP 安排。随着各州获得更多经验，重要的是要监测常见 VBP 安排的设计和实施情况，以评估对医疗补助计划及其服务人群的影响。
