Value-Based Care for Therapy

Healthcare is moving beyond fee‑for‑service toward value‑based care that rewards better outcomes, not higher volume. Value‑based models incentivize efficiency, prevention, coordination, and functional results by linking payment to outcomes achieved per dollar spent while accounting for patient complexity and drivers of health. By 2030, CMS expects all Medicare and most Medicaid plans to hold providers accountable for quality and total cost of care, making value the new standard.

The American Occupational Therapy Association (AOTA), the American Physical Therapy Association (APTA), and the American Speech-Language-Hearing Association (ASHA) have collaborated to identify key concepts and considerations for professionals exploring value-based payment arrangements.

Two resources are provided below. The first is a foundational booklet designed to support practitioners who are evaluating value-based care models and seeking a clearer understanding of their underlying principles.

Topics include:

• What Is Value-Based Care?
• Understanding Upside and Downside Risk in Health Care
• Levels of Value-Based Care
• Quality Measures and Outcome Measures
• Examples of Patient-Reported Outcome Measures
• Risk Adjustment
• What to Look for When Considering a Contract
• Other Important Questions to Ask
• Infrastructure and Upskilling Needs
• Evidence-Based Practice

The second resource is a booklet directed at payers that outlines essential concepts and key considerations when exploring value-based payment arrangements for therapy services. Because these models were initially developed with a physician-focused framework, additional considerations are necessary to ensure that both cost and quality are appropriately measured and incentivized in the therapy setting. Practitioners are encouraged to share this resource with payers to support informed, collaborative discussions about the development and implementation of value-based care arrangements for therapy services.

Topics include:

• Triple Aim to Quintuple Aim
• Leveraging Healthy People to Advance the Needs
• of Vulnerable Populations
• Fragmented Care (Siloed Care)
• Fragmented Care vs. Integrated Care
• U.S. Cost vs. Outcomes
• Alternative Payment Models (APMs)
• Importance of Data
• Operating in a Value Optimization Environment
• Quality Measures
• Risk Adjustment
• What Can Therapy Do for Your Members?

Any questions regarding these resources can be directed to Quality@aota.org or Regulatory@aota.org.

Access these resources to enhance your understanding of value‑based care arrangements. Log in to view the Provider and Payer Guides below.