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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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Leadership Buy-In Resources Overview

This section of the website provides resources intended to help spur leadership action on to new or improved quality efforts. The tools are intended to be used by leaders, but also by other Health Center staff who are determined to solicit the help of leaders on quality work.

Embarking on, or making significant advancements to quality work requires strong Health Center leadership.  Leaders help define how decisions will be made, provide the resources necessary to analyze data and processes, and develop or guide strategic planning efforts that integrate all the functions of a Health Center.  At the highest level of function, quality is driven by organizational culture, rather than strategy.  Here too, leaders play important roles in helping to define and spread culture change throughout an organization.

Health IT & QI Workforce Leadership Buy-In 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

Related Resources

Acknowledgements

This resource collection was compiled by the HITEQ staff with portions contributed by Chris Espersen, HITEQ Advisory Committee member and Independent Contractor and Past President of Midwest Clinicians Network; Shane McBride, Independent Contractor and Past Vice President of Quality and Clinical Systems at South End Community Health Center; Chris Grasso, Associate Director for Informatics & Data Services- The Fenway Institute; and Ed Phippen, Principal - Phippen Consulting, LLC.

Looking for something different or have something you think could assist?

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If on the other hand you know of a great resource already or have one that you have developed then please get in touch with us by clicking on the Share a Resource button below. We are always on the hunt for tools that can better server Health Centers.

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