An introduction to the basic concepts, structures, models, and mechanics of value-based payments.

Many providers have little experience negotiating contracts with managed care organizations. This session will provide an orientation to participants on how to identify potential leverage points for negotiation and how to read and evaluate a managed care contract. In addition, the session will describe a non-adversarial, collaborative approach to negotiation that can be used in negotiating contracts in many situations. Lastly, a tool will be introduced to help participants read and understand a managed care contract.

CMS has signaled its intent to move from strict fee-for-service reimbursement to value-based payment for Medicaid as it has been actively doing for Medicare over the past decade. A few FQHCs are pursuing advanced alternative payment models on their own but most are choosing to clinically integrate with others, especially other FQHCs. This session will share national experiences from these initiatives and provide a framework for evaluating strategic options for DC FQHCs to progress in their pursuit of advanced alternative payment models.

Value is a function of impact and cost. BH providers provide a very high-impact, relatively low-cost service. As such, payment methodologies that reward value should be an opportunity for them to increase their revenue. But that's a theory that only plays out in practice sometimes. Come learn what BH providers need to do to be successful in a value-based environment.

Managed care contracts, like many legal contracts, are challenging to understand. This session will provide a roadmap to key terms commonly found in managed care contracts. The session will explain what these terms mean in plain language and offer examples of favorable and unfavorable terms. In addition, the session will offer pointers for evaluating the favorability of contract terms and describe potential changes to standard terms that participants may wish to address during negotiations.

This webinar will focus on the “why” of transitioning from fee-for-service to capitation to pay for community health center direct services. Dr. Jones will discuss how fee-for-service reimbursement limits patient access to care and hampers efforts to improve patient self-management and accountability for their own health. He will share examples of how innovators are using lessons learned from other service industries to disrupt the healthcare market. Participants will learn how moving away from the fee-for-service system can preserve revenue streams but also support new models of care, and how payment reform can help to address primary care workforce shortages.

The use of measurement-based care (MBC) centers on the use of regular patient-reported outcome measures throughout their treatment. When MBC is used within a patient's standard care, it provides powerful insights to identify treatment targets, determine progress based on symptomology changes, inform adjustments to a shared treatment plan, strengthen the therapeutic alliance, and achieve timely outcomes. This training will introduce MBC as a data-driven method to utilize in VBP to achieve high-quality outcomes.

This session will provide an orientation to quality initiatives implemented by MCOs in their managed care contracts. The session will explain the importance of these quality initiatives, the associated performance measurement reporting, and the contract terms that implement those quality initiatives. In addition, participants will be introduced to the VBP pathway so that regardless of current state of readiness, participants can understand the expectations of quality and be prepared to meaningfully assess these expectations in a VBP contract.

Advances in digital technologies and data analytics have created unparalleled opportunities to assess health data accelerating the ability of science to understand and contribute to improved health behavior and health outcomes. Additionally, behavioral health in the United States is being challenged to address persistent health inequities while improving the quality and value of the care delivered. As regulators, payors, and policies push behavioral health toward data-driven performance, the pressure for behavioral health providers to measure and monitor outcomes increases. This training will introduce providers to the key facets of using data to drive performance including metric selection, diagnosing performance issues and acting on data, driving innovation, and making data analytics a central part of the behavioral health quality strategy.