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Value-Based Payments within Medicaid and Medicare: How to Pay for What Works in Public Health


In this paper, we propose a value-based payment framework that leverages existing Medicaid and Medicare regulatory frameworks, integrates with actuarial processes, and establishes the necessary documentation and payment mechanisms to ensure appropriate compensation for MCOs. Under this framework, value-based payments for services that improve health and reduce costs are coded as medical spending, eliminating the potential issue of rate slide and allowing MCOs to sustain financing these services in the long-term.

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