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.

Access to care is the essential work of health centers, and one pain point is how to ensure specialty access for health center patients. This webinar will discuss innovation in specialty care access using technology and e-Consults. Electronic consultations (“e-consults”) are asynchronous, consultative, provider-to-provider communications within a shared electronic health record (EHR) or web-based platform. E-consults are intended to improve access to specialty expertise for patients and providers without the need for a face-to-face visit.  The Maven Project joined the webinar to talk about the particular challenges in specialty care access in health centers and how e-consults can both improve access and support clinicians, including to help to reduce stress and burnout. The Maven Project supports front-line providers in delivering comprehensive care to patients at health centers and community clinics nationwide.

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. 

The HITEQ Center collaborated with Certintell for a webinar on Preparing for Value-Based Care through Sustainable Telehealth Workflows. The webinar provides an overview of how health centers can use telehealth during the current public health emergency and ensure that they are ready for the shift to Value-Based Care. The webinar covers sustainable telehealth services that are often underutilized and example workflows that have worked for other health centers.

In collaboration with Health Outreach Partners (HOP), AAPCHO continues to promote the importance of documenting social determinants of health (SDoH) interventions to demonstrate the value and scope of health center enabling services (ES). AAPCHO and HOP were joined by the Community Health Care Association of New York State (CHCANYS) to highlight how state, regional, and national partners can leverage SDoH and ES data for Value-Based Payment (VBP).
Through a national webinar, participants learned useful strategies with tools and resources to successfully implement a standardized data collection methodology for the tracking and documentation of non-clinical data. In turn, health center stakeholders, including health center and Primary Care Association (PCA) staff, will be able to articulate or better demonstrate how they are using non-clinical, ES data for VBP. This national webinar was also be conducted for health center and PCA staff to share insights and recommendations on how they plan to use enabling services data for the transition to VBP in their local, state, or regional context.

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.