Payers are in a unique perspective to drive the use of evidence in practice. Whether through coverage decisions, utilization review, or coinsurance, there are many strategies payers use to reflect the value of specific therapies within the marketplace. So, what information do payers feel they need to guide these efforts? Raj Sabharwal, M.P.H., Director at AcademyHealth will discuss his article “Developing Evidence That Is Fit for Purpose: A Framework for Payer and Research Dialogue,” which describes efforts to develop and refine a decision-making framework that considers payers’ perspectives on the utility of evidence generated by different types of research methods, including real-world evidence. Panelists from the National Pharmaceutical Council and AcademyHealth’s Corporate Council and will provide insight into the decision-making framework and will provide perspectives from their own institutions. 

This website includes resources to support health care’s transition to alternative payment models.

Funded by the Robert Wood Johnson Foundation, this case study highlights the successful experiences of AltaMed and three key factors to shaping their role in  payment reform, care delivery transformation, and their financial sustainability. This white paper complements an AltaMed case study written by the Integrated Healthcare Association as part of the same RWJF grant. The case study describes how AltaMed uniquely positioned itself to engage in a diverse array of value based payment models; the models they pursued; and the data used to transform care and ensure financially viable models. 

The document describes a detailed, 10-step process with decision trees and financial models for providers to use when making the case for and considering changes in payment and service delivery.  The document also outlines the kinds of data required in order to submit a sound business case.  This document is also accompanied by a webinar describing it and how to use it.

Description of an evaluation of the Oregon health center Alternative Payment Methodology

An excellent guide to definitions and terms commonly used when discussing payment reform, health care finance, and common value based payment models.

Funded by the Robert Wood Johnson Foundation, this paper discusses four safety net hospitals navigating accountable care efforts and the role of health centers in those efforts.

This research report describes its methodology and findings that Michigan health center Medicaid patients have lower monthly costs compared to Medicaid members who are not health center patients.

This toolkit addresses four key issues for practices interested in engaging with ACOs: 1) Risk management; 2) Referral networks; 3) Actionable data systems; and 4) Patient engagement. The toolkit provides detailed steps to be taken to address these four critical issues.

This 2014 California study compared state Medicaid (Medi-Cal) utilization of a population of adults served by a health center to those in the population who were not. The study found that health center patients were less likely to have an inpatient stay, hospital readmission, and emergency room visit.