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.