Objectives 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. Data sources 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). Study design 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. Principal findings 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. Conclusions 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.

Value-based payment capability maturity model: a conceptual framework

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发表日期：

2026年7月29日

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José Crispim,
Ana Moreira,
Nazaré Rego

摘要

Objectives

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.

Data sources

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).

Study design

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.

Principal findings

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.

Conclusions

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.