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.