In early November, Continuum Health Group hosted a value-based care (VBC) learning collaborative for Advocates for Community Health (ACH), a membership organization comprised of leading federally qualified health centers (FQHCs) focused on advancing health equity, innovation, and health policy. Continuum identified and brought together a group of experts and stakeholders in Washington, DC, to discuss the current state of VBC. This informative and thought-provoking session explored the challenges of implementing VBC payment models, especially for health centers and other safety net providers, and reviewed successful implementation approaches. The participants shared best practices, data collection and assessment tools, research, and noteworthy state-specific programs and models.
The learning collaboration began with a discussion about the business of VBC in the United States and how FQHCs can be a source of innovation and success in the chaos. Then, another subject matter expert discussed the FQHC prospective payment rate (PPS), VBC payment methodology, issues with alternative payment models (APM), and the future of VBC at community health centers. The speaker also discussed the importance of screening for social determinants of health (SDOH) through quality performance measures, and how participating in Centers for Medicare & Medicaid Innovation (CMMI) models such as Making Care Primary (MCP) can be beneficial.
Then, a health plan representative shared the company’s perspective and current initiatives related to VBC. Participants asked questions about the accessibility and affordability of technical and at-home medical products. The conversation also touched on facilitating data-sharing conversations between providers and payers, which could benefit both FQHCs and payers.
Wrapping up Day 1, another subject matter expert described how organizations can methodologically score their readiness to measure outcomes and score their level of technological capabilities to implement behavioral health VBC services. Following the presentation, participants discussed the nuances of behavioral health metrics, the importance of care coordination, and how to integrate behavioral health into primary care.
Kicking off Day 2, former Centers for Medicare & Medicaid Services analyst and Continuum’s own Director Kristen Constantine explained VBC contracts from a non-lawyer perspective, and despite challenges, FQHCs, along with their legal counsel, can negotiate and leverage legal language to develop contracts with the state and payers. She highlighted the importance of definitions of terms like “medically necessary” in contracts and to review any accompanying manuals and methodology papers. Additionally, she pointed out the importance of partnerships beyond payers, such as State Primary Care Associations, State Health Departments, and educational institutions. She closed by noting how Accountable Care Organizations (ACOs) and Managed Care Organizations (MCOs) should discuss and delegate responsibilities.
To close out the learning collaborative, a VBC company CEO described how FQHCs can regain power in VBC negotiations by strengthening their infrastructure, establishing partnerships, and taking on downside risk. Depending on the readiness and scale, larger FQHCs can sometimes regain power in VBC by even acting as the health plan.
VBC is patient-centered care that holds great potential to improve health outcomes, improve patient and provider experience, and control costs. Continuum is proud to facilitate this discussion on the evolving state of VBC and is excited to host future learning collaboratives for interested parties.
