Report Aims to Catalyze Texas Medicaid’s Shift to Value-Based Care
By Emma Freer

A new report aims to accelerate Texas Medicaid’s transition from a fee-for-service payment model to a value-based one, a shift that has been underway for 25 years. 

The Value-Based Payment and Quality Improvement Advisory Committee recently issued the series of recommendations to the Texas Legislature, reiterating the themes of two previous such reports: 

“[S]uccessful [value-based payment] initiatives require broad stakeholder engagement, timely integrated data, minimal administrative burden, and aligned incentives for Managed Care Organizations (MCO) and providers,” the committee wrote. 

The committee’s recommendations focus on “strategies to improve quality and outcomes for patients while reducing cost trends,” including:  

  • Alternative payment models (APMs) in Medicaid; 
  • Value-based care models in home health and pharmacy care; 
  • Nonmedical factors that affect patient outcomes; and  
  • "[T]imely, actionable” data.   

Tyler family physician Janet Hurley, MD, served as a voting member of the committee, which included physicians, nurses, Medicaid plan administrators, hospital representatives, pharmacists, long-term care providers, and other impacted groups. 

Dr. Hurley says a priority is to incentivize Medicaid MCOs to transition to value-based primary care by providing an option for them to address nonclinical factors that impact their patients’ health – without incurring a financial or administrative cost in the process. 

“It is hard to quantify the amount of moral distress caused to physicians when they are aware that a patient has [nonmedical] needs which the clinic has no power to resolve,” she wrote in an email to Texas Medicine Today. “If we could make a meaningful impact on addressing [these outside factors] that impact health, we would have better health in our communities, as well as a sustained and happier primary care workforce.”  

On the APM front, the committee encouraged the Texas Health and Human Services Commission (HHSC) to adopt a more streamlined and comprehensive framework to measure MCOs’ performance and to align this framework with the Centers for Medicare & Medicaid Services Innovation Center’s October 2021 strategy refresh. Among other goals, the strategy refresh aims to increase the number of Medicaid patients in a value-based care model. 

When it comes to home health and pharmacy care, the committee recommended HHSC:  

  • Implement better assessment tools for home health care professionals caring for Medicaid patients; 
  • Increase engagement with accountable pharmacy organizations; and  
  • Develop guidance for MCOs to pay pharmacists for services within their scope of practice.  

The report also directs the legislature to approve at least one service that addresses nonmedical factors of health – such as asthma remediation or housing support programs – and that is covered by state Medicaid plans, to be used in lieu of another covered service.   

Last Updated On

November 02, 2023

Originally Published On

March 01, 2023

Emma Freer

Associate Editor

(512) 370-1383

Emma Freer is a reporter for Texas Medicine. She previously worked in local news, covering city politics, economic development, and public health. A native Clevelander, she graduated from Columbia Journalism School and the University of St. Andrews.

More stories by Emma Freer