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Value-based payment capability maturity model: a conceptual framework
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DOI：10.1186/s13561-026-00807-y.png)
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Abstract
En 中文
To develop a Value-Based Payment Capability Maturity Model (VBP-CMM) that systematizes and guides healthcare organizations in transitioning from volume-based to value-based payment (VBP) systems, providing a structured framework for assessing, developing, and institutionalizing value-based capabilities. Studies published in sources indexed in PubMed, Scopus, or Web of Science (2015–2025), including conceptual or empirical research addressing the structure, implementation, or evaluation of VBP or alternative payment models (APMs). A structured scoping literature review following JBI’s Population, Concept and Context (PCC) guidelines was conducted. An inductive thematic analysis identified core capabilities required for effective VBP management. These findings informed the conceptual development of a maturity model. An illustrative questionnaire and assessment approach were then proposed to demonstrate potential model operationalization. The VBP-CMM structures capabilities progression across five maturity levels, from initial awareness to full integration, supporting continuous improvement. The model offers flexible and restrictive approaches to maturity progression, being adaptable to varied organizational realities. It enables systematic measurement of existing capabilities, prioritization of strategic actions, and alignment between financing, care delivery, and patient value. By diagnosing capability gaps and guiding targeted development, the VBP-CMM can institutionalize value-based approaches in healthcare, fostering sustainable and equitable improvements in clinical outcomes and patient experience. Future research should focus on test model implementation, standardized metrics development, systemic influences evaluation, training, cost analysis, and stakeholder engagement. The proposed model provides healthcare organizations, particularly hospitals, with a systematic and customizable framework to build and evolve VBP capabilities, supporting the broader adoption of value-based healthcare. The accompanying questionnaire and assessment logic should be interpreted as supporting tools for future application and validation. • Maturity models evaluate organizational capabilities and processes; however, very few healthcare-specific adaptations are emerging to address the complexities of regulatory, clinical, and data requirements. The study comprehensively reviews the design, implementation, and governance of value-based payment (VBP) models. • Successful VBP models rely on multiple key components, with care coordination, equity, and quality measurement frequently emphasized. A comprehensive maturity model for VBP was developed, featuring a data collection tool and a multicriteria fuzzy aggregation approach. • A research agenda is presented based on what is emerging and missing from the literature.
Keywords:
Value-based payment
Value-based healthcare
Maturity model
Fuzzy multi-criteria decision-making
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