Value Based Care Basics Module 1

HITEQ Value Based Care Basics Series, June 2023

The Value Based Care Basics training is a three-module series. All three modules can be completed by health center leaders to gain a working knowledge of value based care and how to successfully implement it at your health center. This first module, including the video and companion checklist, uses the Health Care Payment Learning & Action Network (HCP-LAN) Alternative Payment Model (APM) Framework as its basis.

View the 25-minute video to learn about the basic mechanics of how Federally Qualified Health Centers (FQHC) are paid, the prospective payment system (PPS), and how that is evolving over time. The video presentation also reviews the spectrum of value based payment arrangements, using the HCP-LAN framework as a guide, and the capacity needed to be successful in each of those payment categories. You’ll also learn about patient attribution processes, including why that data is so critical in value based payment arrangements, and what questions to ask payer partners about attribution processes, are also reviewed. Lastly, a real value based payment arrangement and related considerations are reviewed.

The checklist walks users through a series of common considerations for contracts that you may receive from payers, with a specific focus on contracts that include value based payment components. After reviewing the framework and watching the video, work through this checklist to be sure you understand these considerations and to help you flag any outstanding issues for legal and/or consultant review prior to execution of the contract.

It is important to understand that contracts can be complicated and no one tool can effectively address all possible contract configurations and their potential issues. Use this module as a guide in conjunction with other resources, access outside expertise when needed, and apply your own knowledge and understanding of your health center. It can also be helpful to ask your health plan representatives if something is not clearly understood.

Learning Objectives: 

After completing this module, participants will be able to: 

• List basic mechanics of the PPS, APM adjustments to PPS, and how these are evolving for FQHCs
• Describe the HCP-LAN APM Framework, including each payment category, and concrete examples of how these payment categories may be reflected in an FQHC contracting environment
• Understand what capacity and infrastructure FQHCs must have in order to be successful in each payment category 
• Recall the current state of FQHC contracting, including case studies of FQHC APMs 
• Explain what to consider as their health center develops a payer negotiation strategy 
• Evaluate payer contracts