Value-based payment (VBP) models aim to improve the value of medical care. There are a variety of VBP models in use that represent alternatives to traditional “fee for service” payment arrangements. For example, capitated payments offer healthcare providers fixed, pre-arranged payments for each enrolled member under their care, bundled payments offer a set payment amount to treat a patient’s condition rather than being paid for each individual service, and pay-for-performance models incorporate a combination of incentives and disincentives that are tied to providers’ ability to meet specific quality and utilization measures. CHSE uses advanced econometric methods to help policymakers understand the impacts of VBP models on the cost and quality of health care.


In 2019, Oregon developed a VBP Roadmap for CCOs as a foundational element of the 2020-2024 CCO 2.0 contract cycle. The following year, the Roadmap introduced requirements to be implemented over the course of the contract. These requirements include the development of new VBP models in specific care areas, and targets for the adoption of VBP arrangements with provider organizations over time.


Hip/knee replacements are the most common inpatient surgeries for Medicare beneficiaries. Comprehensive Care for Joint Replacement (CJR) — Medicare's first mandatory bundled payment program— reflects a national move towards value-based payment. CHSE provides research assessing whether CJR affects disparities in joint replacement care.