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The Quadruple Aim
Quadruple Aim

A Conceptual Framework

Improving the U.S. health care system requires four aims: improving the experience of care, improving the health of populations, reducing per capita costs and improving care team well-being. HITEQ Center resources seek to provide content and direction aligned with the goals of the Quadruple Aim

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Resource Overview

Patient portals, health apps, and the other various personal health information technologies provide great opportunities for increasing patient activation and engagment with their health and their ability to successfully navigate their healthcare system. Furthermore, an increasing number of studies are finding positive outcomes related to the use of these patient-centered tools. While these findings are encouraging, it is still important to assess the effectiveness and fit of these new tools and services when using them to engage a Health Center's community. Effective evaluation can help determine whether a tool is good or bad or simply not the right fit for a particular cohort of patients. In order to determine why a tool is successful or not requires an understanding of the technical, social, and clinical factors that may impact the way a patient interacts with the technology.

The evaluation tools within this resource set provide examples of different measurements that can be used to assess the value and effectiveness of electronic patient engagement tools and services.

Evaluation of Engagement and Satisfaction Resources

Payer Mix Analysis Tool
HITEQ Center
/ Categories: Value Based Payment, Value Based Payment Basics, Data Demonstrating Health Center Value, Engaging in Value Based Payment Models

Payer Mix Analysis Tool

Developed by PCDC in June 2023

This tool was developed in collaboration between Primary Care Development Corporation (PCDC) and the Health Information Technology Evaluation, and Quality (HITEQ) Center.

The intent of this Excel tool is to help health centers with a strategic review of their health plan contracts - across all product lines including Medicaid, Medicare, and Private/Commercial - to ensure their organization's financial sustainability and capacity to expand services to meet community needs.

The tool, available for download below, includes four tabs. Be sure to enable macros when you open the file, in the yellow banner across the top, as those are required for the tool to work as expected.

Tab 1: Health Plan (HP) Review Checklist: This checklist can serve as your initial workplan. It includes key action items for four planning stages, and enables you to identify the person responsible and due dates to help track progress.

Tab 2: Health Plan (HP) Contract Inventory: The template should be used to inventory and organize your existing/active health plan contracts. Keeping this information up-to-date and centrally organized is a key part of managing your revenue cycle and enabling regular conversation with your health plan contacts.

Tab 3: Health Plan (HP) Payer Mix Analysis: This template should leverage data pulled - from your EHR and/or practice administrative programs - to identify patient count, encounter volume, and revenue captured from each health plan business line.
Note: Make sure to include self-pay (sliding fee scale) patients in the blue row provided. Otherwise, your payer mix data may not be accurate.

Tab 4: Health Plan (HP) Payer Mix Visualizations: This template auto-updates leveraging the data provided in in the Inventory tab. This tab provides visualizations and summary tables for your health center's payer mix.
Note: Fields in yellow require data input from the health center. Fields in red are locked and will auto-populate based on your input in the yellow fields.

Disclaimer: The information contained in this tool is intended to equip health centers with general information related to planning and is not intended to replace or serve as a substitute for other tools, templates, and/or expert advice.

Download the resource in the Documents to Download Section below.

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Documents to download

Acknowledgements

This resource collection was cultivated and developed by the HITEQ team with valuable suggestions and contributions from HITEQ Project collaborators.

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