Toolkit: State Strategies to Develop Value-Based Payment Methodologies for Federally Qualified Health Centers
Both states and FQHCs have many things to gain by engaging in the development of value-based payment (VBP) methodologies. VBP methodologies reward providers for improving both health care quality and efficiency. They can incentivize FQHCs to dedicate resources toward developing patient-centered approaches to care delivery that can address social determinants and, ultimately, improve health outcomes.
For states, value-based purchasing is an important policy lever to contain the growth of health care costs and improve quality of care. Including FQHCs in delivery system and payment reforms can help state policymakers improve care and reduce costs for some of their states’ most vulnerable populations who live in underserved areas and align state priorities for quality improvement across Medicaid providers. States are demonstrating that by engaging new stakeholders and understanding the special considerations around FQHC payment, these critical providers can be included in key state innovations.
This toolkit can help state policymakers implement Medicaid VBP methodologies for FQHCs. Based on lessons learned from states during the National Academy for State Health Policy’s (NASHP) Value-Based Payment Reform Academy, the toolkit provides background information, key considerations, and state strategies that address the following:
- Background on FQHCs, value-based purchasing, and key terms;
- Stakeholder engagement;
- VBP methodology development;
- Measurement and reporting; and
- FQHC readiness and practice transformation
Click here to download a PDF of the toolkit or use the buttons below to read each section.
About the Academy
NASHP launched the Value-Based Payment Reform Academy in 2016 to provide support to states interested in developing value-based alternative payment methodologies (APM) for federally qualified health centers (FQHCs) in their Medicaid programs. Six states were competitively selected to participate. Each receives targeted individual and peer-to-peer technical assistance to support the development and/or implementation of an APM.
This work is supported through a National Organizations of State and Local Officials (NOSLO) cooperative agreement that NASHP holds with the Health Resources and Services Administration.
Value Based Payment Reform Academy States and Mentor States
Value-Based Payment Reform Academy states
Browse Our Resources
Stakeholder Engagement
- Resource: Colorado CCHN CHC Alternative Payment and Care Model (APCM) Pilot: Request for Letters of Interest
- Resource: Colorado HCPF/CCHN Shared Intent for FQHC APM
- Webinar: Effectively Engaging Stakeholders to Plan for FQHC Alternative Payment Models (2017)
- Presentation: Engaging FQHCs in Payment Reform Initiatives (2016)
- Presentation: Lessons From Oregon’s FQHC Alternative Payment Methodology Pilot (2016)
Payment Methodologies
- Idaho Develops a Medicaid Value-Based Payment Model for its FQHCs, Based on Cost and Quality, December 2019.
- Resource: Comparison of Oregon and Washington’s Medicaid Alternative Payment Methodologies for FQHCs
- Webinar: Value-Based Alternative Payment Methodologies for Federally Qualified Health Centers: Lessons from Colorado and Minnesota (2017)
- Webinar: What to Consider when Designing a Risk Adjustment Strategy for Value-Based APMs for FQHCs (2017)
- Presentation: FUHN’s Journey: MN DHS’s Integrated Health Partnership (2017)
- Presentation: Healthier Washington and Payment Model 2: Encounter to Value (2017)
- Presentation: Healthier Washington and Washington’s FQHC APM (2017)
- Presentation: Implementing Medicaid Value-Based Purchasing Initiatives with Federally Qualified Health Centers (2016)
- Presentation: Lessons From Oregon’s FQHC Alternative Payment Methodology Pilot (2016)
- Presentation: New Hampshire’s DSRIP Waiver Program, Alternative Payment Models and Safety Net Providers (2017)
- Presentation: Oregon’s Safety Net: Incorporating Value-Based Payment into System Reform (2016)
- Issue Brief: Matching Patients with Their Providers: Lessons on Attribution and Enrollment from Four Multi-Payer Patient-Centered Medical Home Initiatives (2014)
- Blog: Medicaid Ventures into Value-Based Purchasing for FQHCs (2017)
- State Delivery System and Payment Reform Map
- Webinar: Exploring Community Care Cooperative: An All-FQHC ACO Participating in Massachusetts’ Medicaid ACO Program, 2018
- Webinar: State Strategies to Calculate and Analyze Total Cost of Care as part of FQHC Value-Based Purchasing Initiatives, 2018
Measurement
- Resource: Comparison of Oregon and Washington’s Medicaid Alternative Payment Methodologies for FQHCs
- Resource: Oregon APCM Care STEPs Report
- Webinar: Accounting for Social Risk Factors in Value-Based Purchasing (2016)
- Webinar: Value-Based Alternative Payment Methodologies for Federally Qualified Health Centers: Lessons from Colorado and Minnesota (2017)
- Webinar: What to Consider when Designing a Risk Adjustment Strategy for Value-Based APMs for FQHCs (2017)
- Presentation: Engaging FQHCs in Payment Reform Initiatives (2016)
- Presentation: FUHN’s Journey: MN DHS’s Integrated Health Partnership (2017)
- Presentation: Healthier Washington and Washington’s FQHC APM (2017)
- Presentation: Lessons From Oregon’s FQHC Alternative Payment Methodology Pilot (2016)
- Presentation: Oregon Primary Care Association’s APCM Introduction/Overview (2017)
- Presentation: Using Data to Measure Performance: Advancing Value-Based Payment Methodologies for FQHCs and RHCs (2016)
- Webinar: Exploring Community Care Cooperative: An All-FQHC ACO Participating in Massachusetts’ Medicaid ACO Program, 2018
- Webinar: State Strategies for Collecting and Using Data to Drive Policy and Clinical Improvements, 2018
- Webinar: State Strategies to Calculate and Analyze Total Cost of Care as part of FQHC Value-Based Purchasing Initiatives, 2018
Policy Levers
FQHC Readiness
- Resource: Participation Agreement for Oregon’s Alternative Payment and Care Methodology (APCM)
- Webinar: Value-Based Alternative Payment Methodologies for Federally Qualified Health Centers: Lessons from Colorado and Minnesota (2017)
- Presentation: Clinic Readiness, Preparation and Support (2017)
- Presentation: Engaging FQHCs in Payment Reform Initiatives (2016)
- Presentation: Lessons From Oregon’s FQHC Alternative Payment Methodology Pilot (2016)
- Webinar: Supporting FQHCs to Transition to Value-Based APMs, 2018
Rural Health Centers
For individuals living with complex, often chronic conditions, and their families, palliative care can provide relief from symptoms, improve satisfaction and outcomes, and help address critical mental and spiritual needs during difficult times. Now more than ever, there is growing recognition of the importance of palliative care services for individuals with serious illness, such as advance care planning, pain and symptom management, care coordination, and team-based, multi-disciplinary support. These services can help patients and families cope with the symptoms and stressors of disease, better anticipate and avoid crises, and reduce unnecessary and/or unwanted care. While this model is grounded in evidence that demonstrates improved quality of life, better outcomes, and reduced cost for patients, only a fraction of individuals who could benefit from palliative care receive it. 
