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Value-Based Care for Community Health Centers
June 3: Session #1 – Primary Care Capitation: The Clinical Imperative
California FQHCs have adopted a care team model approach as Patient Centered Medical Homes. However, fee-for-service reimbursement policy limits use of non-billable members of the care team and non-billable venues, even when clinically appropriate and preferable from a patient perspective. This webinar will describe clinical models of primary and behavioral care that become financially sustainable under the FQHC APM 2.0 and how that flexibility will become increasingly important to FQHCs in the future. We will also offer a brief update on how recent actions at the federal level may influence clinical models and the APM.
By the end of the session, participants should be able to:
- List at least three ways in which a capitated FQHC APM can serve as a tool for increasing market share, attracting and retaining workforce, and succeeding in value-based care.
- Describe how adult populations can be managed differently under a combination of a capitated FQHC APM and total cost of care APM including the medically uninsured.
- Describe how pediatric populations can be managed differently under a combination of a capitated FQHC APM and total cost of care APM including the medically uninsured.
June 10: Session #2 – FQHC APM 2.0: Tweaking the Model
Despite years of design sessions and negotiations among constituents, adoption of FQHC APM 2.0 has been disappointing to say the least. Other states have pursued capitated alternative payment models for FQHCs, also with protracted development phases. California’s capitated FQHC APM is unique as is the prevalence of professional capitation by FQHC-led IPAs, but experience in other states offers suggestions for addressing the challenges unique to APM 2.0. These potential modifications will be discussed.
By the end of the session, participants should be able to:
- Describe at least two approaches to alternative payment model implementation and how they differ from the CA APM (especially regarding shared savings, shared risk, and global risk for total cost of care; and delegation of care management responsibilities).
- Identify at least three promising or best practices for addressing the poor correlation between managed care PCP assignment and where patients receive their primary care.
- List at least two critical success factors for value-based care in the FQHC/community clinic environment.
Presented by Art Jones. MD, Principal and Helen DuPlessis, MD, MPH
Complimentary for CCALAC Members and Affiliates
Instructor Biographies
Art Jones, M.D. has 27 years of experience as a primary care physician and CEO at Lawndale Christian Health Center. The health center has taken a population health approach from its beginning, addressing the social drivers of health as well as the medical needs of the community it serves. The health center was an early adopter of advanced alternative payment models dating back to 1987. Dr. Jones was an architect for the first capitated Federally Qualified Health Center (FQHC) alternative payment methodology in the country in 2001.
Dr. Jones was one of the founders and continues to serve as the Chief Clinical Officer for Medical Home Network (MHN) and MHN ACO, comprised of fourteen FQHCs and three health systems serving 190,000 Chicago area Medicaid recipients. MHN is completely delegated for care management and successfully operates under a global risk arrangement on total cost of care. MHN supports 80 FQHCs in Medicare ACO projects.
Dr. Jones is also a principal at Health Management Associates where he focuses on helping FQHCs and their clinically integrated networks succeed in advanced alternative payment models. He serves as the FQHC subject matter expert to CMMI for the Making Care Primary payment demonstration.
Dr. Jones is a graduate of the University of Illinois Medical School and completed internal medicine residency, chief residency, and a cardiology fellowship at the University of Chicago.
Dr. DuPlessis is an accomplished pediatrician and physician executive with leadership experience in maternal and child health policy and programs, health management, program and policy development, practice transformation, public health, community systems development, performance improvement, government-sponsored programs and managed care.
She is currently a physician principal at Health Management Associates (HMA), where she is working with state and local agencies, health provider groups, professional associations and community-based organizations on understanding, readiness assessment and implementation related to CalAIM. She heads the HMA Team on the evaluation of the Child and Youth Behavioral Health Initiative. She continues to direct or serve as subject matter expert on numerous substance use disorder initiatives at the state and local level for multiple populations including adults, pregnant and parenting persons and adolescents. She continues to work with a variety of community clinic networks, local sites and tribal clinics on performance improvement and with several maternity care initiatives on sustaining alternative pregnancy care models.
Dr. DuPlessis served as the chief medical officer with St. John’s Well Child and Family Center and at L.A. Care Health Plan earlier in her career. She was a senior advisor to the UCLA Center for Healthier Children, Families and Communities where she provided leadership, research, program development support, counsel and representation to local, state and national MCH efforts; and to community level systems transformation aimed at improving early childhood school readiness. She served as Director of Student Medical Services for the LA Unified School District and as a regional Medical Director responsible for CHDP and CCS administration in the Los Angeles County Health Department.
This training is generously sponsored by LA Care
