Ask William Riley about the traditional fee-for-service patient payment model used by most health clinics in the U.S., and he doesn’t mince words.
“Payment for service is helping bring us to the bottom when it comes to poor health outcomes in this country,” said Riley, director of the National Safety Net Advancement Center at Arizona State University.
Riley joined other national experts on primary care payment reform in Houston last week to help Federally Qualified Health Centers (FQHCs) learn about moving to a value-based payment model focused on a patient’s health outcomes, instead of the current system of payment based on the number of clinic visits.
The learning event was hosted by the Episcopal Health Foundation (EHF), St. David’s Foundation (SDF) and the Robert Wood Johnson Foundation (RWJF). Leaders from 14 FQHCs across Texas attended the event.
“Valued-based payment reform is the wave of the future,” said Elena Marks, EHF’s president and CEO. “Increasingly, this is how clinics will be paid by Medicaid and other health insurance plans. Payers want value. There’s a focus on health, not just healthcare, and it has the potential to help dramatically improve community health.”
The explanation of a value-based payment system sounds simple — doctors and clinics are paid for keeping people healthy and improving their health, not on the volume of medical services they provide. The goal is increased quality of care, improved health outcomes, and lower costs across the board. But implementing an effective value-based payment system inside clinics can be challenging.
“Payment reform is like chess, you have to think about things far in advance,” said Jason Fournier, CEO of West Side Community Health Services in Minnesota.
Fournier described several value-based payment projects at 10 of West Side’s clinics as tools to address health disparities in a new way. Some projects focused on reducing emergency room visits by Medicaid patients and others linked patients to social services for housing and transportation. Fournier said those projects we’re not only cost-effective, they delivered services that resulted in better health and allowed physicians to spend more time with patients.
“It’s not about money, it’s all about transforming the way we work with our patients,” Fournier said.
Representatives from the Texas Health and Human Services Commission, Texas Association of Community-Based Health Plans and UnitedHealthcare Community Plan of Texas each said their organizations are using value-based payment models for safety-net clinics with smaller groups of patients. From coordinated care to rewards for quality measurements, they said value-based care models continue to evolve and improve.
Following the learning event, EHF, SDF and RWJF will be working with the HealthCare Quality Institute to survey clinics across Texas about their readiness for value-based payment. EHF and our partners will use the survey findings to develop a learning collaborative for safety-net clinics to help FQHCs explore payment reform design and implementation options. EHF wants to help these clinics move into the world of value-based payments by providing learning opportunities and technical assistance to do this work.
