Value-Based Purchasing

Value Based Purchasing (VBP) is a concept by which "purchasers" of healthcare (government, health plans, employers, and consumers) hold the healthcare system (physicians, hospitals, health plans, etc) accountable for both quality and cost of care. VBP begins with data models to support continuous healthcare quality improvement as well as to educate healthcare consumers. Also inherent in VBP are incentives to reward and encourage better decision making by providers and consumers.

The American Academy of Family Physicians (AAFP) recognizes the urgency to improve both efficiency and quality in the delivery of medical care, including VBP as one approach. However, given the technical, legal and ethical challenges in designing and implementing VBP, it is imperative that physician measurement processes used in VBP should be transparent and adhere to the AAFP policies on "Performance Measures Criteria," "Physician Profiling," "Data Stewardship," and "Transparency."

The AAFP supports VBP programs that adhere to these principles:

  1. Focus on improved quality of care
  2. Support the physician/patient relationship
  3. Utilize performance measures based on evidence-based clinical guidelines
  4. Involve practicing physicians in program design
  5. Use reliable, accurate, and scientifically valid data
  6. Provide positive physician incentives
  7. Offer voluntary physician participation

Based on these principles, the AAFP will use its influence to support and encourage the utilization of the following guidelines:

  1. The purpose of VBP should be to improve quality of care to patients and their communities.
  2. VBP should enhance adherence to evidence-based practice guidelines and measures endorsed by the National Quality Forum.
  3. VBP should be based on reliable, valid, verifiable, and transparent data.
  4. VBP should be flexible in the following ways:
    1. Responsive to community needs, preferences and resources
    2. Adaptable to different practice organizational models, structures of care, and physician specialties
    3. Responsive to individual preferences and socio-cultural backgrounds
    4. Respectful of differences in adoption of health information technology (HIT) while encouraging its effective spread
  5. VBP should be accountable to purchasers, consumers, and providers.
  6. VBP should encourage the establishment of robust patient-centered medical homes, including the systems and HIT that are structurally necessary.
  7. VBP should involve multidimensional and comprehensive measurement.
  8. VBP should advance knowledge of effective and efficient episodes of care.
  9. VBP should recognize explicitly the tradeoffs in value decisions.
  10. VBP should be sensitive to issue of health disparities.
  11. VBP should create alignment of incentives among clinicians, systems, patients, and communities.
  12. VBP should recognize, disclose and balance the administrative burden and costs to clinicians and the health systems of measurement and participation in VBP with the incentives of the program.
  13. VBP should recognize the path of quality improvement in the medical practice and system, and not solely the outcome.

(2009 COD)