North Dakota Wins National Recognition for Hospital Value-Based Purchasing Program

Oxon Hill, Md.— The National Association of Medicaid Directors (NAMD) today announced that North Dakota Medicaid, within North Dakota Health and Human Services, has been awarded the 2026 Spotlight Award for its hospital value-based purchasing (VBP) program, which ties a portion of hospital payment to measurable improvements in quality and health outcomes.

Since 2021, North Dakota Medicaid has worked alongside the state’s largest prospective payment system (PPS) hospitals, a technical vendor, and clinical partners to design and implement the program. Today, nearly 60% of North Dakota Medicaid fee-for-service members are attributed to a participating hospital, putting those hospitals in position to be true champions of better outcomes.

“Our hospital value-based purchasing program is about rethinking how we pay for care. Instead of paying for more services, we’re focused on better outcomes, better experiences, and better value for the people we serve,” said Krista Fremming, Assistant Medicaid Director for North Dakota. “At its core, this program says quality matters here. Prevention matters. Closing gaps in care matters. We’re using Medicaid’s purchasing power to drive better health for North Dakotans.”

Measurable Improvements in Preventive Care

Comparing 2022, before the program began, with 2025 performance, participating hospitals achieved statistically significant improvements in care for children and adults:

• Child and adolescent well-care visits rose from 45.2% to 57.0%, meaning 2,871 more children received an annual well-care visit
• Well-child visits for babies and toddlers rose from 54.4% to 61.1% in the first 15 months of life and from 42.4% to 57.1% between 15 and 30 months
• Topical fluoride treatments for children rose from 14.7% to 20.1%, reaching 1,507 more children
• Breast cancer screening nearly doubled, from 28.4% to 55.2%, driven in part by work with hospitals to close data gaps and identify women who needed screening

“North Dakota shows that value-based purchasing can work in a state with a diverse mix of urban, rural, and critical access hospitals when it is built on trust, credible data, and a realistic pace of change,” said Kate McEvoy, Executive Director of the National Association of Medicaid Directors. “Their steady, partnership-driven approach, grounded in what matters for members, is a model for states and territories.”

About NAMD’s Spotlight Award

The National Association of Medicaid Directors’ annual Spotlight Award recognizes exceptional leadership and innovation in Medicaid administration. The award highlights achievements that demonstrate excellence in driving value through improved member experience and efficient use of taxpayer resources. Learn more about the other 2026 winners here.