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Value-Based Purchasing Authority: 2016 Managed Care Regulations and Pay for Success

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By Andrew Olson, Michael McKnight

The Centers for Medicare and Medicaid Services (CMS) published new managed care regulations on 25 April 2016 that went into effect after 24 June 2016. They provide a way forward for states to create broadly applicable value-based purchasing frameworks that enable managed care entities to undertake service-delivery innovation and, if desired, finance the projects using Pay for Success mechanisms. They do require a collaboration between federal, state, and local parties – especially in the approval of managed care contracts.

GHHI will actively work to leverage this option to move forward its Pay for Success portfolio of 11 projects, where applicable.

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