Value-Based Care
Reimbursement models that pay providers based on quality and outcomes rather than fee-for-service volume.
1 min read · Last reviewed May 23, 2026
At a glance
- Category
- Compliance Program
- Primary sources
- 1
- Workspace handoff
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Where this comes up
Compliance committees and practice managers operate at this level — written policy, workforce training, sanction policy, monitoring and auditing cadence, response and corrective action. The seven elements of an effective compliance program (OIG) are the scaffolding; this term lives somewhere on that scaffold.
Full definition
What it is in practice
CMS drives value-based care through MSSP ACOs, Medicare Advantage, primary-care models (e.g., Making Care Primary), and bundled payments.
How it shows up in your practice
Value-based contracts require operational discipline in quality measure reporting, HCC capture, and total-cost management.
Sources
- CMS — Quality Payment Programhttps://qpp.cms.gov/
Look up value-based contract details in Ask D3
Open ask d3 →Related terms
- Compliance ProgramAccountable Care Organization (ACO)A group of providers that takes accountability for the quality, cost, and overall care of a defined patient population.
- Compliance ProgramMIPSMerit-based Incentive Payment System — the QPP track combining quality, cost, improvement activities, and promoting interoperability into a single composite score that adjusts Medicare payment.
- Compliance ProgramAdvanced APMAn Alternative Payment Model that meets QPP criteria (including downside risk) and qualifies participating clinicians for a 5% lump-sum incentive payment.
- DocumentationHCC (Hierarchical Condition Category)The CMS risk-adjustment model that groups ICD-10 codes into categories used to predict the cost of care for Medicare Advantage enrollees.
- PayerMedicare Stars RatingFive-star quality rating system CMS publishes annually for Medicare Advantage and Part D plans.
D3rx is a healthcare-billing and compliance research aid maintained by D3rx Inc. Articles are drafted by an LLM (Anthropic Claude) against primary HHS, OCR, CMS, eCFR, NIST, and state-regulator publications, and reviewed for restraint and source fidelity by the D3rx team.
Reviewer status: a named credentialed reviewer (CHC, CHPC, or healthcare attorney) is being engaged. Until that engagement is finalized, this page does not claim credentialed review.
Related across the archive
- GlossaryAccountable Care Organization (ACO)A group of providers that takes accountability for the quality, cost, and overall care of a defined patient population.
- GlossaryAdvanced APMAn Alternative Payment Model that meets QPP criteria (including downside risk) and qualifies participating clinicians for a 5% lump-sum incentive payment.
- GlossaryMIPSMerit-based Incentive Payment System — the QPP track combining quality, cost, improvement activities, and promoting interoperability into a single composite score that adjusts Medicare payment.
- GlossaryHCC (Hierarchical Condition Category)The CMS risk-adjustment model that groups ICD-10 codes into categories used to predict the cost of care for Medicare Advantage enrollees.
- GlossaryMedicare Stars RatingFive-star quality rating system CMS publishes annually for Medicare Advantage and Part D plans.
- GlossaryReadmission Reduction Program (HRRP)CMS program that reduces payments to hospitals with excess 30-day readmissions for certain conditions.
- BillingWhat to Do When a Payer Says You're UnderbillingGot a letter saying you're underbilling? Here's what it actually means, whether you should worry, and what action to take.
- ComplianceAmbulatory Surgery Center Compliance: CMS + State + Infection Control42 CFR Part 416 Conditions for Coverage, CMS State Operations Manual Appendix L, the ASC Infection Control Surveyor Worksheet, and where state ASC licensure tightens the standard.
This glossary entry is a research aid for billing and compliance staff. It does not provide legal, medical, or financial advice and does not replace counsel. References cited link to primary sources at HHS, OCR, CMS, eCFR, NIST, and the relevant payer or industry body.