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Value-Based Care: Definition and Healthcare Context
Full name: Value-Based Care Delivery and Payment Model
Value-based care is a health care delivery model in which providers are reimbursed based on patient health outcomes and care quality rather than the volume of services rendered. Contrasted with fee-for-service payment, value-based arrangements include quality metrics, total cost-of-care targets, and shared savings or shared risk provisions. CMS administers value-based care programs through the Innovation Center (CMMI), including Accountable Care Organizations, bundled payment models, and Primary Care First. The model aims to reduce unnecessary utilization while improving clinical outcomes.
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Last updated: 2026-07-11Reviewed by: Dr. Jennifer Montecillo, MD — Gullas College of Medicine, 2019. Non-practicing medical reviewer.
How it’s used
- CMS QPP MIPS: MIPS is a value-based payment program that adjusts Medicare clinician fees based on performance scores.
- CMS Care Compare: star ratings published through Care Compare function as a quality accountability mechanism that underpins value-based contracting.
Frequently asked questions
- What is value-based care?
- Value-based care is a payment model that ties provider reimbursement to the quality and efficiency of care rather than the number of services delivered.
- How does value-based care differ from fee-for-service?
- In fee-for-service, providers are paid per visit or procedure. In value-based care, providers are rewarded for good outcomes and penalized for poor quality or excessive spending.
- What CMS programs are value-based care programs?
- CMS value-based programs include MIPS, Shared Savings ACOs, Bundled Payments for Care Improvement, and Primary Care First, among others.