Value-based care has gained a strong foothold in Ohio through the Comprehensive Primary Care (CPC) and Episodes of Care programs. With the state fully embracing the idea of person-centered care backed by performance-based incentives, FQHCs have an exciting opportunity to showcase their successes and earn financial incentives for doing so.
The attractive incentive structure and clear quality guidelines make CPC a promising entry point for FQHCs that wish to begin or extend their value-based care journey.
(Want the deep dive into the value-based care landscape in Ohio? Download our guide here.)
So how can FQHCs participate in this vibrant state environment and maximize their opportunities to achieve clinical and financial success?
State officials appear wholly committed to the CPC program, which is well aligned with other industry transformation efforts, such as those taking place in Medicare and in the commercial value-based care environment.
The enrollment period for CPC and CPC for Kids occurs annually in October for the following program year, giving FQHCs regular opportunities to join one or both of the programs.
To prepare for entering the world of value-based care through CPC, FQHCs should consider how the program will impact current and future operations, prepare staff with education and support, and choose experienced, dedicated partners to help make the transition to the next phase of patient-centered healthcare.
Develop a solid understanding of what value-based care means for FQHCs
FQHCs are generally well equipped to take on financial responsibility for proactive, preventive healthcare delivery, because they are already mission-driven to offer services in this manner.
However, it can be difficult for overworked, under-resourced FQHCs to parse through the nuances of value-based care models to understand exactly how these programs will affect their financial and clinical activities.
For more comprehensive insight into the impact of value-based care on community health delivery, FQHCs should remember that they don’t have to reinvent the wheel.
The transition to value-based care has been ongoing for close to a decade, and there are both peer advisors and expert organizations, like independent provider associations (IPAs), available to share their experiences and give actionable advice to FQHCs new to the field.
Assess readiness to embrace practice transformation efforts
Making the shift to value-based care requires a combination of financial, clinical, technical, and cultural changes. FQHCs should conduct a full readiness assessment before applying for new models to ensure the program is a good fit.
This assessment should include baseline financial and clinical performance metrics, a look at opportunities to build community-based partnerships, and a thorough examination of technical and reporting capabilities including risk stratification and risk adjustment, performance monitoring, health information exchange, and other population health management needs.
Examine opportunities to participate in complementary value-based care initiatives
Medicaid is a major source of revenue for most FQHCs, but it isn’t the only way that FQHCs are reimbursed for their services. Many FQHCs in Ohio and elsewhere have opportunities to maximize their investment in practice transformation by signing on to additional value-based care models with other payers, as well. CPC is just the beginning of the journey for FQHCs across the state.
While Ohio CPC has predetermined performance criteria and payment structures, other models require negotiation between participants and sponsors. FQHCs looking to expand their participation in the value-based care environment should carefully consider whether they have the in-house expertise to establish an advantageous contract on their own.
If not, seeking out a partner, such as an independent provider association (IPA) to reduce administrative burdens and supplement internal resources could be the key to securing favorable terms with payers and making sure that the organization is making the most of their initial transformation efforts.
Educate and engage staff to generate sustained buy-in
New requirements demand new workflows and a new approach to the complex relationships between patients, providers, payers, and the community at large. Making these changes isn’t always easy for FQHC clinicians and administrative staff, especially if they are not fully prepared to dive into a different way of doing things.
Proactive, comprehensive, and continuous education is the key to generating staff buy-in – and keeping the workforce motivated for the long term. FQHCs should offer multiple opportunities to educate staff members on upcoming changes and should make a point to collect staff feedback and answer questions during the transition.
Being transparent about changing workflow patterns, openly listening to staff concerns, and celebrating milestones will be crucial for developing a culture of continuous improvement, which may improve the odds of success for the FQHC as a whole.
Success depends on solid preparation, ongoing engagement in practice transformation, and having experienced, committed partners to inform and guide FQHCs during their shift away from fee-for-service payments. With the right knowledge, strategies, and partners, FQHCs in Ohio can achieve success within CPC, Episodes, and any programs that may follow as the state continues to blaze a trail toward a more efficient, effective healthcare ecosystem.
Download our guide to get the full picture of the opportunities for FQHCs in Ohio to participate in value-based care.