Value-Based Payment Data Exchange Opportunities

This guide presents findings from the CAQH CORE environmental scan on value-based payment (VBP) data exchange conducted in 2022. It outlines the evolution of operational opportunity areas identified in 2018, which include interoperability, data uniformity and standardization, risk adjustment, quality measurement, and patient attribution. The report details the challenges stakeholders face, particularly in achieving data uniformity and interoperability, which are crucial for effective VBP implementation. It emphasizes the importance of addressing social determinants of health (SDOH) and health inequities within VBP models. The report also discusses the complexities of patient risk stratification and the need for consistent methodologies in patient attribution. Furthermore, it highlights ongoing efforts to simplify quality measurement reporting and the incorporation of social risk factors into quality assessments. The findings aim to inform future steps for CAQH CORE and the broader healthcare industry in advancing value-based care initiatives.