The Affordable Care Act and Value-Based Purchasing: What’s at Stake for Children with Medical Complexity?

The implementation of the ACA shifted the structure and design of public and private health care delivery and payment systems. In order to curb health care spending and improve quality of care and health outcomes, there has been tremendous attention to value as a criterion for health insurance options offered by payers. Value-based purchasing strategies, primarily (1) pay-for-performance (P4P); (2) accountable care organizations (ACOs), and (3) bundled payments, are geared towards achieving value by reducing costs while improving quality based on a predetermined set of performance standards including quality and cost measures. These strategies are discussed in this policy brief.