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Value-based payment approaches for children’s primary health care services are urgently needed to improve quality of care, to incentivize the use of health promotion services (especially in early childhood) that can prevent costly health conditions in the future, and to overcome chronic fragmentation in care. New York’s Medicaid program has designed a VBP approach specific to children’s health services and is actively seeking opportunities to pilot it with managed care plans and primary care providers. The proposed payment model is intended to give primary care providers increased resources and flexibility to invest in strategies, such as social needs screening, that promote optimal child health and can potentially reduce long-term health care costs.
This case study discusses New York’s pursuit of child-centered VBP approaches in Medicaid, which could be a model for other states and stakeholders pursuing efforts to promote high-quality health care for children, and especially for those states participating in the federal Integrated Care for Kids demonstration project.