Events

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.

What does VBP really mean for BH providers (beyond P4P)? How do you get to an advanced APM as a BH provider?

One of the greatest threats to success for clinically integrated networks is an uneven commitment from disparate providers to improve patient outcomes and reduce avoidable, low-value healthcare costs. Success depends on providers investing time and other resources to achieve performance targets. Although the distribution of value-based payments should certainly take into consideration the number of patients either attributed or served, it must also recognize the contribution each entity made to generate the incentive payments. This webinar will explore principles and examples of distribution methodologies aimed at fairly allocating those dollars.

Value-based payment reimbursement links payment to the quality and effectiveness of the care we deliver. This webinar considers the clinical strategies used to achieve valuable outcomes and demonstrates that the care delivered is effective, including care management, integrated/whole-person care, and measurement-based care.

Medicare, state Medicaid agencies, managed care organizations, and commercial insurers are increasingly adopting value-based payment (VBP) models. Community Health Centers (CHCs) are uniquely positioned to deliver on that high expectation by offering enhanced access to high-quality primary care, coordinating the care delivered by specialists, hospitals, and other institutions, and care managing the most complex individuals. This requires CHCs to transform their care delivery to efficiently deliver optimal patient- and population-level health outcomes and successfully manage costs. Many CHCs are forming clinically integrated Networks to create contracting leverage, make joint investments in data analytics, and collaborate to develop complex care management and clinical models of care. This webinar will explore that national trend and how it may apply to District of Columbia CHCs.