Value-Based Payments: Intellectual and Developmental Disabilities Quality Indicators Associated With Billing Expenditures.
Quality metrics predict two-thirds of service costs—use them to pick providers who deliver both high care and lower bills.
01Research in Context
What this study did
Carli and the team looked at billing records for long-term supports and services.
They wanted to see which quality scores best predict yearly spending.
All clients had intellectual or developmental disabilities and lived in the USA.
What they found
Quality indicators explained two-thirds of the cost differences.
High-quality providers cost less than poor-quality ones.
This means good care saves money, not just lives.
How this fits with other research
Hall (2010) already showed supported employment pays for itself.
Carli’s work adds that quality metrics can steer contracts toward those cost-saving providers.
de Leeuw et al. (2024) found huge regional price swings in Irish residential care.
Carli’s model says watch quality, not just geography, to control bills.
Bigham et al. (2013) gave us the BSP-QEII audit tool.
Pair it with Carli’s cost formula and you have both a ruler and a price tag for behavior plans.
Why it matters
You can now write value-based contracts that reward the right things.
Ask providers for their quality scores before you sign.
Use the same scores to decide bonus pay or continued funding.
This turns good care into a business case, not just a moral one.
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02At a glance
03Original abstract
Although managed care is expanding into the intellectual and developmental disabilities (IDD) service system, there is little agreement about measurable and meaningful outcomes for people with IDD, including for use in value-based payments (VBP). In this study, we examined potential VBP metrics for people with IDD-relationships between quality and costs. We analyzed Basic Assurances data and long-term services and supports billing data from 68 human service organizations that supported 6,608 people with IDD. Our final hierarchical regression model predicted 66.40% of the variance of annual long-term services and supports (LTSS) billing per person. Our findings suggest quality assurance indicators can account for a significant portion of cost variance-quality metrics represent a potential for cost savings and efficient service delivery.
Intellectual and developmental disabilities, 2021 · doi:10.1352/1934-9556-59.4.295