Overview
With the generous support of Cedars-Sinai, IHQC and Capital Link designed and launched the Making the Value Connection (MVC) Program in 2019. With continuous movement toward value-based reimbursement and care delivery, both organizations leveraged their respective strengths in strategic planning, financial assessment, and quality improvement capacity building to support community clinics in incorporating a comprehensive definition of value into their strategic priorities.
Twelve community clinics from the Los Angeles area participated across two cohorts of the MVC program. Participating teams addressed projects around specialty referrals, outreach and enrollment, Health Homes, empanelment, and more through the lens of the Value Equation.
MVC Pilot Cohort
Five community health centers formed a team of senior leadership and staff leads from finance, operations, and quality improvement. Each team designed and implemented a Value Project to apply the MVC program’s suggested approaches, selecting a project focus from a list of strategic priorities linked to the organization’s strategic plan.
The Value Project included a comprehensive measurement plan including factors of access, service, quality, and cost to demonstrate impact. Projects included improving referrals, increasing understanding of data at the front line level, and improving complex care delivery under the Health Homes pilot programs.
Participation in the MVC Pilot Program benefited clinics in several ways, shown in the table below:
For more information about the MVC Pilot, access the “Making the Value Connection (MVC) Whitepaper (2020).”
MVC Expanded Cohort
Amid the throes of the COVID-19 pandemic, seven teams participated in a virtual 12-month MVC program. Priority projects for these teams included care coordination, empanelment, colorectal cancer screening, diabetes, the launching of a new clinic site, behavioral health integration, telehealth implementations, and dental services.
Case Study
One participating clinic incorporated financial metrics across some of their 2020 QI initiatives like diabetes care, telehealth, and patient engagement/satisfaction. For their diabetes improvement initiative, their team met with their CFO to analyze how quality metrics impact clinic revenues. Through participating in the MVC Program, and working more closely with the Finance Department, this QI department gained a deeper understanding of the multiple factors impacting revenues (wrap around rate, CAP rate, PPS Rate, Total Payments received, etc.). Their analysis showed how the Clinical Practice Guidelines (quarterly visits for diabetes patients) also coincided with scenarios that generated the most revenues for the clinic. With a more holistic understanding of “value”, their QI team is now focusing their improvement efforts on diabetes patients with < 2 visits and >8 visits in the last 12 months.
The participating team also made new connections with local health plan and IPA representatives to understand the pay for performance and quality incentive payment targets – which can be directly linked back to a number of their current QI efforts around colorectal cancer screening. Overall, the team shared how their Quality department now has a deeper understanding of the financial metrics and drivers that should be monitored with their QI efforts, and are meeting with their finance department on a regular basis.