NACHC Internship NACHC Internship Experience Alisha Reginal Public Policy Intern | State Affairs National

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  • NACHC Internship Experience

    Alisha Reginal Public Policy Intern | State Affairs National Association of Community Health Centers April 21, 2017

  • Agenda

    • Payment Reform • Background

    • New Jersey

    • Colorado

    • Kentucky

    • Social Determinants of Health • New York

    • Conclusion

  • Payment Reform

    1Instead of PPS, states may implement an Alternative Payment Methodology (APM) to reimburse FQHCs, as long

    as each affected FQHC agrees and total reimbursement is not less than it would have been under PPS.

    Payment for Performance

    Payment for Delivery System Transformation

    (PCMH)

    Base Payment

    (FQHC PPS/APM1)

    Incentive

    Investment

    Flexibility

  • Payment Reform

    1Instead of PPS, states may implement an Alternative Payment Methodology (APM) to reimburse FQHCs, as long

    as each affected FQHC agrees and total reimbursement is not less than it would have been under PPS.

    Payment for Performance

    Payment for Delivery System Transformation

    (PCMH)

    Base Payment

    (FQHC PPS/APM1)

    Incentive

    Investment

    Flexibility

  • Payment Reform

    Payment for Performance

    Payment for Delivery System Transformation

    (PCMH)

    Base Payment

    (FQHC PPS/APM1)

    Incentive

    Investment

    Flexibility

  • Payment Reform

    Payment for Performance

    Payment for Delivery System Transformation

    (PCMH)

    Base Payment

    (FQHC PPS/APM1)

    Incentive

    Investment

    Flexibility

  • • Value-Based Payment Models • High-utilizers

    • Care Coordination

    • Shared Savings

  • • Value-Based Payment Models • Medicare Shared Savings Program

    • Colorado’s Accountable Care Collaborative Plan • Care Coordination

    • FQHC APM

  • • Value-Based Payment Models • PCMH - Care Coordination

    • Shared Savings with MCOs

    • Medicare Shared Savings Program ACO

  • Payment Reform Challenges

  • Payment Reform Impacts

    • Quality impacts reimbursement

    • Collaboration

    • Social Determinants

  • Social Determinants of Health

  • https://www.pinterest.com/pin/489907265701462215/

  • Health Homes

    • ACA – Section 2703

    • Care coordination and management services for Medicaid beneficiaries with complex healthcare needs

    • New York’s criminal justice pilot programs • Develop and test models to connect individuals to healthcare and social-

    services post release

  • • Housing, employment, education, behavioral health, health

    • Care managers for Health Homes patients

  • Conclusions

    • Policy and management are intricately interwoven

    • Health centers are awesome!

  • alishareginal6@gwu.edu