Imagine you're a plumber. You sign the contract, do the work, and then the homeowner tells you they're withholding 10 percent of what they owe you. You can earn it back, but only if you outperform every other plumber in the city that year
That's not an incentive program. That's a penalty with extra steps.
Medicaid value-based payment is already here. More than 20 states now operate some form of VBP program for nursing facilities, and the stakes are real. The question isn't whether it comes to your state. The question is what kind of program you'll be dealing with when it does.
At Quality Summit on April 13, AHCA Senior Vice President John Kane will break down what's wrong with how most programs are designed and what good design requires. His team reviewed 30 Medicaid VBP programs across 24 states. Fewer than 15 percent met evidence-based design standards.
AHCA Senior Vice President John KaneMany programs rank facilities against each other rather than against a fixed benchmark, meaning you can improve and still lose payment because someone else improved faster. Research on the Medicare SNF VBP program found 72 percent of facilities took a cut in year one, with the steepest hits falling on those serving low-income and high-acuity residents.
Good design produces results. Tennessee's QuILTSS has run for over a decade with near-universal voluntary participation and documented quality improvements. Kane will show exactly what makes it work and why so many other programs don't.
Before joining AHCA/NCAL in 2025, Kane led Medicare Fee-for-Service Reimbursement at CMS. He knows how these programs are built and where they break down.
If you've ever sat across from a state agency and felt like the rules were written against you, this session is for you.
Quality Payments and Quality Care: The Complicated Relationship Between Medicaid VBP and Base Rate Adequacy
Monday, April 13, 2026 | AHCA/NCAL Quality Summit | Baltimore, MD