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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

  • Rationale
  • Challenges
  • Approach

Mobile health (mHealth) tools have the potential to play a pivotal role in fostering a sense of greater patient engagement within underserved populations. By facilitating patient use of mHealth applications in collaboration with electronic health record (EHR) and personal health record (PHR) systems there is an opportunity to empower individuals to take a more active role toward managing their health conditions.

The proliferation of consumer mobile health applications and devices is creating new opprotunities for engaging patients in their care and leaves little doubt as to the impact that these tools will have on the way that people manage their health, health information, and health communications with their care providers, family and friends. This shift to increased self-management of health by consumers will change a patient’s relationship with their doctor and the way healthcare is practiced.
The current laws and standards in place to ensure patient’s privacy and health information security will need further review to determine whether mobile health technologies create unique situations that are not yet addressed. This poses many challenges for health centers as to how best to support patient use of these tools and ways in which to incorporate them into their own clincial support systems.

Mobile health characterizes a shift in the point of care for the patient. The point of care has classically been located at the hospital or clinic. Mobile health is beginning to shift this model so that the point of care is more frequently a matter of where the person happens to be located at that time, consequently providing opportunities for more timely care. It is also important to note that these tools help to increase the accessibility of Healthcare to populations where direct access to Healthcare professionals is limited and so health management is more frequently left in the hands of the consumer.

The tools provide in this resource cover a range of different mobile health tools, strategies, and guidelines for consideration as Health Centers seek to leverage these technologies to better engage and activate their patients.

Mobile Health 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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