Glossary of managed care and value based payment terms that may be useful to health centers and health center stakeholders beginning to explore this topic.

How to Use This Checklist:
This is a supplement to our Module 2: The Managed Care Data Set, which uses the HCP-LAN APM Framework as its basis. Review both before using this checklist. There are terms used throughout that may be new to you or may benefit from detailed explanations—please visit our Value Based Payment Glossary for basic definitions for a host of key terms.

This checklist will walk you, the health center, through a series of common considerations for contracts you may receive from payers with a specific focus on contracts that include value-based payment components. This document assists organizations in understanding the necessary data and data-related tools for managing population health within a managed care environment. It is a primer on the types of best-practices that are necessary to maximize care delivery models that are responsive to value-based payment programs. Follow this checklist to further your understanding of these considerations and to help flag any outstanding issues for legal and/or consultant review prior to execution.

It is important to understand, contracts can be complicated and no one tool can effectively address all possible contract configurations and their potential issues. Use this as a guide with other resources, access outside expertise when needed, and apply your own knowledge and understanding of your business. It also never hurts to ask the health plan representatives if something is not clearly understood.

In this 25 minute video we cover the basic mechanics of how FQHCs are paid, the prospective payment system, and how it is evolving over time. We also review the spectrum of value-based payment arrangements using the HCP-LAN framework as a guide. We also discuss the capacity needed to be successful in each of those payment categories. Patient attribution process, including why that data is so critical in value-based payment arrangements, and what questions to ask payer partners about attribution processes are also reviewed. Lastly, a real value-based payment arrangement and related considerations are reviewed.

This spreadsheet developed by the HITEQ Center provides a crosswalk of Clinical Quality Measures and their electronic specifications as defined in the 2022 update for Eligible Professionals (Clinicians). Fields include the crosswalk of measures with related information about CMS, NQF, and MIPS ID, and Telehealth Eligiblity, as well as inclusion in CY2022 UDS, Million Hearts, NCQA digital quality measures (dQMs), Quality Rating System Measure Set, CMS Adult / Child Medicaid Core Measures Set, and MSSP ACo Performance Pathway. Links are included throughout.

Food insecurity has doubled since the onset of the COVID-19 pandemic in March 2020, and has tripled among families with children. Not having enough access to food is a key contributor to negative health outcomes for adults and children alike, and it is important now more than ever for health centers to identify and support patients who are experiencing food insecurity.
This resource is designed to support health center efforts to identify and assist patients who are experiencing food insecurity. It outlines key considerations around integrating social determinants of health (SDoH)-related screening and intervention into the electronic health record (EHR) workflow, highlights standardized screening tools and data elements to monitor the prevalence of food insecurity among patients, and describes several strategies to meet food-related needs. 

Panel management is an essential function of a health center. When done well, it smooths the scheduling and operations of the health center; when done poorly it creates challenges with productivity, patient continuity, Quality Improvement reporting, and more. This resource offers guidance on improving panel management activities, including real-life examples from two health centers of the challenges and successes in managing panels.

This resource will equip health center stakeholders with the understanding of what data-related capacity is needed to succeed under risk-based payment models.

This resource will equip health center stakeholders with the understanding of how standardized social determinants of health (SDoH) data can be used and which ICD 10 Z codes can be used to document a patient's social needs, and are therefore pertinent to a standardized SDoH data set.

The purpose of the infographic is to describe how SDH data would be used for a variety of goals that would have traction with the clinic staff audience who may likely need to modify workflows and behavior in order to collect such data.  The visual case could be used in presentations or hung on a provider break room wall.

This resource will equip health center stakeholders with the motivation, knowledge, and ability needed to collect and use standardized social determinants of health data.

This brief describes how El Rio Community Health Center engaged payers to help identify high risk patients and optimize the health of all of their patients through patient-centered, coordinated care.

This brief describes Sunset Community Health Center’s efforts to transition to a value based payment with shared savings under Medicaid managed care.

This customizable document uses health center data to support them in demonstrating their value to potential partners and key stakeholders. The document provides evidence for how health centers align with the Triple Aim.

This document offers an overview of the Affordable Care Act (ACA) Section 1332 waiver option (or “state innovation waiver”) and key information to help health centers engage in the development of state innovation waivers in their states.

This HITEQ brief introduces value-based payment and role of health centers as payment models shift. The brief answers key questions about health centers’ engagement in value-based payment, including health-center specific Alternative Payment Methodology (APM), reasons to engage in payment reform, the shifts in primary care payment going forward, and the transition to value-based payment.

This HITEQ brief outlines Medicare Access and CHIP Reauthorization Act (MACRA) MACRA, what it signals for payment reform, and when it impacts health centers.

This web-based tool helps health centers assess and identify areas for improvement in key competencies needed to successfully engage in the most prevalent and emerging payment reform models.

This 2014 California study compared state Medicaid (Medi-Cal) utilization of a population of adults served by a health center to those in the population who were not. The study found that health center patients were less likely to have an inpatient stay, hospital readmission, and emergency room visit.

This toolkit addresses four key issues for practices interested in engaging with ACOs: 1) Risk management; 2) Referral networks; 3) Actionable data systems; and 4) Patient engagement. The toolkit provides detailed steps to be taken to address these four critical issues.