AHCCCS Payment Modernization - Value Based Purchasing


Through value based purchasing, AHCCCS is committing resources to leverage the State’s successful managed care model to address inadequacies of the current health care delivery system such as fragmentation, and to continue to lead efforts to bend the health care cost curve to sustainable levels.

Below are new models that have been implemented by AHCCCS Managed Care Organizations within their provider networks:

Payment for Performance: Pay‐for‐performance is a term that describes health‐care payment systems that offer financial rewards to providers who achieve, improve, or exceed their performance on specified quality and cost measures, as well as other benchmarks.

PCMH: The patient‐centered medical home is a way of organizing primary care that emphasizes care coordination and communication to transform primary care into "what patients want it to be."

Shared Savings: Shared savings models have a baseline budget or target that is used to determine whether savings were achieved. Savings which result are shared between the payer and the provider. Quality measures are usually part of the shared savings methodology.

Bundled Payment: A single, "bundled" payment covers services delivered by two or more providers during a single episode of care or over a specific period of time, and usually includes accompanying quality requirements.