Value Based Care

Centene Corporation is a national leader in developing, deploying and supporting Value Based Payment (VBP) programs in multiple lines of business.   Since Centene began implementing VBP programs, it has consistently demonstrated its commitment to an integrated model of care that aligns with each state Medicaid agency’s framework in order to best support the goals and objectives of the respective markets.

A central component of Centene’s VBP strategy is to develop patient-centric and integrated care models that address the unique challenges faced by different cohorts of Medicaid populations. Through national experience serving Medicaid populations, Centene has learned that simple concepts with elegant solutions go a long way in the early stages of system-wide transformation. 

Centene’s VBP strategy is built on several core tenets of accountable, patient-centered care.  First and foremost Centene health plans diligently foster engaged relationships with their PCP network.  They also promote integrated health homes, by facilitating physical and behavioral health coordination to better serve members.  By offering a range of VBP models Centene meets providers where they are and positions them for success in the right incentive model.  And Centene also incorporates incentives a continuum of VBP programs to ensure seamless transitions between care settings.   

Centene, and its affiliates nationwide have embraced the Quadruple Aim as the yardstick for measuring successful health care delivery transformation within its VBP offerings.  Centene firmly believes that delivering on the Triple Aim (enhanced patient experience, improving population health, and reducing costs) requires provider engagement, a sustainable work life balance, and viable and satisfactory business models for providers (the 4th aim). Centene supports a flexible programmatic approach to VBP objective setting, which is rooted in provider engagement.

This programmatic approach prioritizes the following considerations: 

  • The ability to measure and track progress of system-wide transformation within each VBP arrangement
  • VBP arrangements which emphasize integrated, member-centric care to addresses unique needs of different Medicaid populations
  • Offering VBP models that assess providers where they are today and provide support and infrastructure that take them to where they want to go
  • Partnering with providers to successfully achieve practice transformation and the transition to VBP

Eighty percent of Centene’s members receive services from providers who participate in VBP arrangements with successful providers demonstrating an encouraging impact on outcomes, including:

  • 25% higher Quality Scores
  • 1-2% lower costs: 10-15% lower IP admissions
  • ~20% lower ED rates
  • 3-30% in additional payouts to providers (as of April 2016)

This experience and proven success provides a rich base of lessons for new Centene health plans to build upon and support payment transformation across their markets.