Are You Ready for Payment Reform?
Friday, May 20, 2016
Kersten Burns Lausch
Are You Ready for Payment Reform?
By: Kersten Burns Lausch, NACHC, and Stacey Moody, JSI
Editor's Note: Kersten Burns Lausch, Manager of State Affairs at NACHC, and Stacey Moody, Senior Consultant at JSI, gave a presentation on state payment reform experiences and health center readiness at the 2016 NWRPCA Annual Spring Conference.
Across the nation, health care delivery systems and payment models are transforming to respond to the tenets of the Triple Aim: improving patient experience and population health while reducing system costs. The Affordable Care Act (ACA) has stimulated the testing and spread of new delivery models, a shift toward value-based payments and the development of resources for system-wide improvement.
Health centers, through their mission, structure, and programmatic focus, have a unique ability to provide high-quality, cost-effective care that engages patients, and thus contributes substantially to the achievement of the Triple Aim. At the same time, payment reform and delivery system transformation efforts have critical implications for health centers’ financial performance, sustainability, and their mission of providing high-quality, patient-centered care to underserved populations in an increasingly competitive market. Not all health centers are currently prepared to effectively engage in payment reform activities.
To prepare for engaging in such efforts, health centers could benefit from undertaking four key steps:
- Develop and maintain a robust understanding of payment reform efforts in the state and local environment.
- Ensure a clear, shared vision of their organization’s role in achieving the Triple Aim that can be used to assess emerging payment reform opportunities.
- Critically assess current operations and capabilities.
- Work collaboratively with other health centers, stakeholders and partners to accelerate transformation of the health care delivery system.
The National Association of Community Health Centers (NACHC) and John Snow Inc. (JSI) recently partnered to develop tools and resources to support health centers as they take these steps, including the Payment Reform Readiness Assessment Tool. This tool identifies key competency areas needed for successful health center engagement in the most prevalent and emerging payment reform models. It is designed to help health centers assess their current state of readiness, and to identify areas for improvement in the four domains consistently identified in the literature as being important to the success of service delivery redesign and payment reform initiatives. These are:
Since its launch, the tool has been utilized by health centers to assess their own readiness, and has helped them to think strategically about the future in collaboration with their primary care association and other health centers in their state. Lessons from the tool and information on how health center payment reform is being approached at the state level was shared by NACHC and JSI at the 2016 NWRPCA Annual Spring Conference in Anchorage. Visit NACHC’s website to access the tool and other payment reform resources.
- Organizational leadership to pursue and guide payment reform efforts (including leadership in the development of partnerships);
- Change management and service delivery transformation;
- Robust use of data and information to support payment reform efforts; and
- Financial and operational analysis required for successful participation in payment reform initiatives.