National Health Outreach and Engagement Conference 2024

Myers, A, Eschbach, C, and Lytle, L.
Value-based care (and value-based payments) are a movement that is meant to create a cost-
effective, high quality, and health promoting health care system. Value-based care in Medicare
and Medicaid government insurance programs also creates the conditions for Health Extension
professionals to become a health promotion and disease prevention partner of choice for health
care providers and payors.

Value-based payments involve a payor (e.g., a private health plan, Medicare, Medicaid) offering
a provider (e.g., physician) a higher or incentive reimbursement amount, if and when a patients’
health status improves. This is a marked distinction from “fee-for-service” payments where a
payer offers a provider the same reimbursement amount, without regard to whether a patients’
health status improves. The inequities in health outcomes seen in population statistics are
attributed to many factors including social conditions and the policies that influence those
conditions such as access to health care and the quality of available care. Promoting health and
well-being – particularly for diverse individuals and population groups who are most at risk for
poor health outcomes – require well-designed educational approaches and changes in policies
and systems. Changes in the ways that the U.S. health care system funds and rewards payors
has implications for those wishing to partner to improve the health of all people.

For example, Oregon’s Coordinated Care Organizations (geographically based Medicaid
insurance networks) are incentivized to provide “Comprehensive Diabetes Care”, which is
operationalized as “the percentage of patients 18-75 years of age with diabetes under care of the
CCO who had hemoglobin A1c > 9.0%” (showing ‘poor control’) during a measurement
period. Other incentive metrics are related to child and adolescent immunizations, mental health
and substance use screenings and follow up, and commercial tobacco use. The metrics
connected to value-based care payments are already areas that Cooperative Extension is
engaged in for community-based education and health promotion outreach. In this newer
movement, value-based care and payment approaches have created financial incentives for
health systems to re-shape the ways they provide care, and where they invest in health
promotion and disease prevention activities. Opportunities exist to strengthen partnerships
between providers, payors, and Cooperative Extension professionals, for collective movement
towards creating a health care system that truly promotes healthy behaviors and healthy
communities. The Center for Medicare and Medicaid Services (CMS) has tried for decades to
advance quality improvement initiatives that address health disparities. CMS’s quadruple aim
pushes the need to improve patient health, provide better healthcare experiences, reduce costs,
and to increase efforts in preventive health and chronic disease self-management.

This presentation will provide an overview of value-based care as it relates to Health Extension
and Cooperative Extension’s National Framework for Health Equity and Well-being; share
relevant Federal and state-level examples of value-based incentives that are matched to the
content areas of Cooperative Extension programs and are therefore opportunities for
collaboration; describe potential benefits and challenges related to Health Extension
partnerships with providers and payors; and, offers a listing of reputable organizations and
resources where Extension professionals can learn more about this topic.