{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T10:19:08Z","timestamp":1787653148477,"version":"build-2736575974"},"reference-count":46,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"vor","delay-in-days":11,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Services Research"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess the impact of primary care value\u2010based payment implementation on low\u2010value service use among Medicaid beneficiaries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Setting and Design<\/jats:title>\n                    <jats:p>On July 1, 2021, North Carolina Medicaid launched the Advanced Medical Home (AMH) program to improve care quality and coordination under managed care. Health plans are now required to include financial incentives for care coordination and performance in contracts with the highest\u2010tier primary care practices (Tier 3 AMHs). Leveraging the tiered structure of the program and using a difference\u2010in\u2010differences design, we compared changes in low\u2010value care utilization before and after the AMH rollout among beneficiaries attributed to Tier 3 AMHs versus those in lower\u2010tier or non\u2010AMH practices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources and Analytic Sample<\/jats:title>\n                    <jats:p>We used North Carolina Medicaid institutional and professional claims, managed care encounters, and enrollment and provider files, supplemented with information on provider characteristics. The analytic sample included 33.6\u2009million beneficiary\u2010months, representing 1.34\u2009million nonelderly adult beneficiaries and 7903 primary care practices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Principal Findings<\/jats:title>\n                    <jats:p>Beneficiaries attributed to Tier 3 AMH practices and comparison practices had similar baseline rates of low\u2010value care, with imaging for plantar fasciitis (31.2% vs. 28.9%), head imaging for uncomplicated headache (14.8% vs. 14.5%), and back imaging for nonspecific low back pain (13.8% vs. 13.8%) being the most commonly used low\u2010value care services. Although rates for many low\u2010value services declined over time, adjusted difference\u2010in\u2010differences estimates were small in magnitude and not statistically significant for low\u2010value care outcomes included in the study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The results suggest limited effectiveness of value\u2010based payment reform in curbing low\u2010value service use among Medicaid beneficiaries in North Carolina. However, more time may be needed to observe substantial effects, given the gradual nature of practice transformation. Strengthening financial and quality\u2010based incentives, including specific low\u2010value care benchmarks, also could enhance the program's effectiveness in reducing unnecessary care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1475-6773.70149","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T13:46:31Z","timestamp":1786542391000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effect of Primary Care Value\u2010Based Payment Implementation on Low\u2010Value Care Among Medicaid Beneficiaries in North Carolina"],"prefix":"10.1111","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4360-8505","authenticated-orcid":false,"given":"Aniyar","family":"Izguttinov","sequence":"first","affiliation":[{"name":"Department of Health Policy and Management University of North Carolina  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4845-6261","authenticated-orcid":false,"given":"Marisa Elena","family":"Domino","sequence":"additional","affiliation":[{"name":"Center for Health Information and Research, Arizona State University  Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6169-7847","authenticated-orcid":false,"given":"Mark","family":"Holmes","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management University of North Carolina  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher M.","family":"Shea","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management University of North Carolina  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2270-751X","authenticated-orcid":false,"given":"Darren A.","family":"DeWalt","sequence":"additional","affiliation":[{"name":"Department of Medicine University of North Carolina  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5970-8359","authenticated-orcid":false,"given":"Carolyn T.","family":"Thorpe","sequence":"additional","affiliation":[{"name":"Eshelman School of Pharmacy University of North Carolina  Chapel Hill North Carolina USA"},{"name":"Center for Healthcare Evaluation, Research, and Promotion, Veterans Affairs Pittsburgh Healthcare System  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,12]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2022.01397"},{"key":"e_1_2_10_3_1","volume-title":"How Does the Quality of the U.S. Health System Compare to Other Countries? 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