Description of an evaluation of the Oregon health center Alternative Payment Methodology

Funded by the Robert Wood Johnson Foundation, this paper discusses four safety net hospitals navigating accountable care efforts and the role of health centers in those efforts.

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

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 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.

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.

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.

Funded by the Robert Wood Johnson Foundation, this case study highlights the successful experiences of AltaMed and three key factors to shaping their role in  payment reform, care delivery transformation, and their financial sustainability. This white paper complements an AltaMed case study written by the Integrated Healthcare Association as part of the same RWJF grant. The case study describes how AltaMed uniquely positioned itself to engage in a diverse array of value based payment models; the models they pursued; and the data used to transform care and ensure financially viable models.