The National Safety Net Advancement Center is proud to work closely with six safety net organizations from across the U.S. to identify solutions to challenges posed by payment and care delivery reform. These projects will contribute to the growing evidence base on how to successfully implement payment and care delivery reforms in safety net organizations.
Government and commercial payers are leading a shift from volume-based to value-based reimbursement. Given the patient populations that they serve, safety net organizations may be uniquely positioned to address underlying causes of poor health and provide the kind of high-value, outcomes-focused health care that new payment models are designed to support. However, safety net organizations face unique significant upfront technical and operational challenges with implementing value-based payment models due to limited financial and administrative resources.
Meet our Grantees
AltaPointe Health Systems (Mobile, AL)
“Using Risk Stratification to Offer Coordinated Care Management in a Behavioral Health Organization”
As a risk-bearing member of a regional care organization, AltaPointe manages behavioral health services for Medicaid patients and is also invested in managing overall medical spend. In preparation for a shift in payment from Fee-For-Service Medicaid to managed care in October 2016, AltaPointe is redesigning aspects of care delivery for some patients. The technical assistance provided through this funding will help AltaPointe to create a system for risk stratification to optimize utilization of targeted interventions. The identification of effective strategies for data-driven, acuity-based patient activation is anticipated to bolster the nascent evidence-base in this area.
Chickasaw Nation (Ada, OK)
“Transforming the Care Team in an Integrated Primary Care Clinic”
Chickasaw Nation Medical Center, a leading tribal health center, will be utilizing new software for service data capture, forecasting, and analytics in order to support care delivery reforms. The new software will centralize multiple data sources to enable quality reporting, tracking and outcome forecasting, and sharing of data across internal systems. Technical assistance provided in the project will facilitate quality improvement efforts related to care delivery reforms possible with the new data capacities.
Guadalupe County Hospital (Santa Rosa, NM)
“Preserving Access to Rural Care – Clinical Integration Initiative”
Guadalupe County Hospital and project team will work with to integrate health care services across frontier hospitals in six New Mexico counties. Using state-wide Medicaid claims data, the project will identify system utilization patterns to enable data-driven clinical service integration. Armed with claims and service utilization data and a large collaborative team of stakeholders, the project will retain technical assistance expertise to develop alternative payment model and gain-sharing methodologies.
Hudson River Healthcare (Tarrytown, NY)
“Advancing Value-Based Care in NY’s Hudson Valley”
Hudson River Health Care co-founded the first IPA of safety net primary care and behavioral health providers in New York State. The IPA is currently developing its first value-based payment arrangement with a managed care organization. The goal of this project is to help build capacity for Hudson River Health Care to 1) establish the ability to identify high-cost/high-risk patients; 2) define an approach for coordinating their care; and 3) agree upon a methodology for allocating potential revenues and losses.
Lutheran Social Services of Illinois (Des Plaines, IL)
“Moving toward Value – Financial and Data Infrastructures Improvements”
In previous experiences with value-based contracting, Lutheran Social Services of Illinois (LSSI) was asked to propose a rate structure early in contract negotiations. The organization lacked necessary data and expertise to produce solid contract rate proposals based on organizational costs. Through this project, LSSI will obtain technical assistance consultation to solidify a value-based rate structure. The barriers and facilitators to contract rate development identified in this setting is anticipated to inform others transitioning to value-based payments.
Primary Health Inc. (Urbandale, IA)
“Risk Stratification and Care Coordination in a Health Center Network”
Eleven of Iowa’s FQHCs have joined together to form an integrated primary care network known as IowaHealth+ (IH+). The move towards value-based contracting and IH+’s network-based approach necessitate that health centers standardize risk stratification and associated care coordination strategies across organizations. Technical assistance will be provided to align risk stratification and prioritization of populations across Iowa’s health home programs and IH+’s value based purchasing contracts. This will inform the development of the model care coordination strategy and identify potential barriers to successful implementation.