Case Study

Missouri Launches Successful Value-Based Payment Transformation

Collaboration with Guidehouse provides innovative support in home- and community-based settings to enhance quality of life for people with intellectual and developmental disabilities.


The Missouri Department of Mental Health’s Division of Developmental Disabilities offers supportive services to enhance the quality of life for those with developmental disabilities by ensuring their health and safety, promoting community engagement, and fostering employment opportunities. More than 16,000 Missourians benefit from these person-centered supports, which are provided through home- and community-based services (HCBS) settings to promote independence. 

The Division wanted to institute a value-based payment (VBP) program for people with intellectual and/or developmental disabilities that would provide innovative care and support in HCBS settings using the Centers for Medicare & Medicaid Services’ Home- and Community-Based Services 1915 (c) waiver. The waiver lets states target vulnerable populations and provide services to those who would otherwise be eligible only in an institutional setting. Despite years of planning and partnership to design and gain legislative approval and funding for the VBP transformation, the Division would have difficulty implementing and sustaining such a program without the requisite expertise and sufficient staffing capabilities. 



The Division turned to Guidehouse to fill this critical staffing gap for the Missouri VBP program. By providing an experienced implementation team with extensive prior experience at state agencies, we were able to leverage that background knowledge to offer invaluable support with navigating the complexities of implementing VBP models. The scope of that support included:

Technical infrastructure and data management. We oversaw the design, updates, and management of the web-based portal, facilitating collection and analysis of critical program data. This involved developing and refining data collection tools and processes to ensure that the program had access to accurate, timely data for decision-making and reporting.

Provider engagement and support. Working closely with Missouri to engage providers, our team offered training and support to ensure that providers understood all VBP program requirements and were able to meet them. This included developing resources, establishing continuous communication and feedback channels between the state and providers, hosting office hours, and providing one-to-one technical assistance meetings to support provider success.

Monitoring, evaluation, and continual improvement. We facilitated ongoing program monitoring and evaluation, including reviewing VBP records submitted by providers through the online portal and providing dedicated email support for responding to inquiries. This oversight ensured that the program's objectives were being met and that continual improvements to implementation processes could be made to effect better outcomes.

This comprehensive support enabled the Missouri Division of Developmental Disabilities to successfully implement and sustain the innovative VBP program despite the challenge of not having additional staff allocated for these initiatives.

“We are very thankful for good partners like Guidehouse that can come in and help us implement the value-based payment initiatives. They already have the background knowledge [because] many of them came from state agencies themselves. That has been immensely helpful in allowing our team to achieve program success.”

— Jessica Bax, Division Director


This collaboration has resulted in the launch of one of the most expansive and transformative VBP programs of its kind in the U.S. and demonstrated the feasibility to successfully implementing a VBP model in FFS HCBS. Since its inception, the program has:

  • Successfully engaged 187 providers, surpassing the state’s initial target of engaging 25% of all providers
  • Served more than 3,000 clients, underscoring the program’s extensive reach and ability to significantly improve the quality of care and services received by individuals with developmental disabilities
  • Facilitated the disbursement of more than $2.6 million in incentive payments to participating providers, satisfying Missouri’s commitment to rewarding providers who meet and exceed established quality and outcome benchmarks
  • Generated more than $3.37 million in cost avoidance through the Remote Supports VBP incentive and reallocated over 98,000 direct care hours to fill critical gaps in the current workforce shortage

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