Distinguish between payer-initiated and provider-initiated value-based arrangements.

• A. Payer-initiated arrangements are designed by providers to influence member care.
• B. Payer-initiated arrangements are designed by payers to influence member care; provider-initiated arrangements are designed by providers/health systems to improve outcomes and share savings.
• C. Both types are designed by government agencies.
• D. Provider-initiated arrangements discourage sharing savings.

Answer: (B)

The key idea is who designs value-based arrangements and why. Payer-initiated arrangements are created by payers (health plans) to influence how members receive care, aiming to control cost and improve quality for the enrolled population. Provider-initiated arrangements are created by providers or health systems to improve patient outcomes and to share any savings generated from better performance.

This makes the correct choice the best one: it separates who drives the arrangement and aligns it with the intended outcome—payers shaping care patterns for their members, and providers organizing care delivery with shared savings in mind.

Why the other options don’t fit: design by providers for payer-initiated scenarios is the opposite of how these tend to work; government agencies aren’t the primary designers of these arrangements (they regulate and oversee, but the contracts and models are typically payer- and provider-led); and provider-initiated models generally involve sharing savings rather than discouraging it.