Payment Reform In California The Next Era for Health Center Care Delivery Is Coming Health Care Symposium April 1, 2016 Ralph Silber Executive Director,

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Presentation transcript:

Payment Reform In California The Next Era for Health Center Care Delivery Is Coming Health Care Symposium April 1, 2016 Ralph Silber Executive Director, Alameda Health Consortium CEO, Community Health Center Network

Community Health Center Network (CHCN) CHCN is an IPA/MSO, contracting with the 2 Medi-Cal managed care plans in Alameda County with 134,000 managed care members. Member Health Centers: Asian Health Services Axis Community Health La Clínica LifeLong Medical Care Native America Health Center Tiburcio Vasquez Health Center Tri-City Health Center West Oakland Health Council

Opportunities Enhancing alignment with CHC mission. Improving access to care, quality of care, and health outcomes. Addressing workforce challenges. Strengthening our position in the health care system and marketplace.

Challenges Change is hard Data, data, data Financial risk Its complicated Need for Investment Funds

Which Members Will Be In The APM Pilot ? Pilot will involve only Medi-Cal Managed care members assigned to the CHC site in the pilots Excluded: Dual Eligibles Emergency/Pregnancy Only Managed Care Patients Not Assigned to the Site Medi-Cal Expansion members may or may not be in the pilot; stay tuned

Important Questions Do you know who your assigned members are, by site & by eligibility category? What percentage of your visits/patients at your site will be in the pilot?

Living in a Fee-For-Service World While We Are Preparing to Transition to a Value-Based World Behavioral Care Case Management Addressing Social Determinants Population Health: Patients vs. Members Improving HEDIS Scores Alternative Touches