HMB2 - Building Data and Workforce Capacity to Partner with Payers - an HCCN Initiative

Session Description: Opportunities for FQHCs to participate in advanced value based care models have been limited in Pennsylvania. Health Federation, an independent regional network that leads a statewide HCCN, was approached by a Medicaid MCO with an interest in creating sufficient scale to support a shared savings agreement across multiple health centers. HFP took on this challenge, ultimately contracting with the payer and six health centers in Southeast Pennsylvania for a combined panel of 13-16,000 members.

The Network project experienced many of the challenges faced every day by individual health centers trying to partner successfully with payers. However, by centralizing some functions at the Network, building on HCCN infrastructure, and working with a single payer in a highly fragmented environment, we were able to tackle and begin to overcome some of these quandaries. Our principal challenges were data - sharing, management, and reconciliation; workforce - defining roles and hiring/retaining; communications (between centralized staff and individual health center teams as well as with the payer), defining the scope of work for the centralized staff, and streamlining workflows to avoid duplication.

After five years, the program continues, has generated revenue for health centers and the Network, improved patient outcomes, and contributed to a sophisticated data capacity, built on the population health management software used by the Network and participating health centers. This presentation will demonstrate that value based care programs can be built from the ground up, even without a major initial infusion of resources, forming the basis for expansion and growth.