Healthcare Data GlossaryPayer
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.
Last updated: 2026-06-17Reviewed 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.