Medicaid Business Transformation DC
Medicaid Business Transformation DC offers DC Medicaid providers tools and resources to deliver value-based care and to succeed in value-based payment arrangements to improve whole-person care and outcomes. Funded by the DC Department of Health Care Finance (DHCF), the initiative provided free technical assistance in the form of legal, clinical, financial, and business development support to help your organization align payment with the delivery of more accessible, equitable, coordinated, and accountable person-centered care.
The Medicaid Business Transformation DC: Recommendations for Technical Assistance Report shares insights on provider-specific challenges and needs for technical assistance (TA) focused on financial, operational, and legal capacity to improve readiness to deliver value-based care, along with policies and best practices for the District and DHCF that are drawn from leading-edge states to advance value-based care and transform the healthcare delivery system. The report includes findings from a literature review of national value-based payment (VBP) best practices, published materials, and a scan of the District’s healthcare reform landscape, along with results from focus groups, interviews, and a TA survey with District stakeholders.
Key findings from the report include:
- District healthcare organizations/providers have specific TA needs, and providers exhibit significant variation in their understanding of and readiness for a transition from fee-for-service to VBP models.
- Nationally, successful states advance VBP by building on the Health Care Learning and Action Network (HCP-LAN) framework to develop additional guidance for managed care organizations, with criteria, benchmarks, and standards that include both medical and behavioral health expenditures. These states also provide free TA, upfront investments, and resources to prepare healthcare organizations to deliver high-quality value-based care.
- The transition to VBP for states across the country can take multiple years and significant technical support to prepare healthcare organizations to transform business, legal, and financial operations. This work includes supporting provider readiness for success with advanced payment models (APMs) and facilitating provider collaboration and integration through individual and system-level transformation (such as mergers, acquisitions, and formation of provider-level entities). Examples include accountable care organizations, clinically integrated networks, and provider-led entities (PLEs).
Program Contacts
Amanda White Kanaley
Project Manager
Email Amanda
Caitlin Thomas-Henkel, MSW
Project Director
Email Caitlin
Samantha Di Paola
Project Coordinator
Email Samantha
Program Goals
- Prepare health care organizations to succeed in delivering value-based care to improve patient outcomes.
- Expand quality measurement to capture more data on outcomes to inform care delivery, payment incentives and population health.
- Make key operational and financial system changes for accountable care transformation.
- Align payments with value-based care goals to move towards models that encourage coordination and health promotion.
Medicaid Business Transformation Resources
Value-Based Payment Foundations
Topic
Behavioral Health
Topic
FQHCs
Topic
Legal & Contracting
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