Building the Foundation
The key activities below will guide you through the process:
- Take a multidisciplinary approach to sustainability planning.
- Use the Business Case Tool to develop financial projections for care team expansion.
- Continue using the Business Case Tool to monitor financial outcomes (actuals vs. projections) and make midcourse corrections.
After working through the key activities, you will be able to:
- Form a multidisciplinary team to complete the Business Case Tool.
- Complete the Business Case Tool with a multidisciplinary team.
- Develop an implementation plan that includes necessary care team functions for population health management and have it approved by your organization’s leadership.
- Implement the plan.
As you begin, a few notes about using the Business Case Tool:
- Remember this is an Excel-based tool; data entry is going to be the most consuming part of engaging the tool.
- As you are entering data and working with the tool, regularly save your file, to avoid losing data.
- Once you have your data entered, make a duplicate copy of your file. That way, if you accidentally change a formula or get tangled up, you’ll have a fallback option.
Key Activity 1: Take a multidisciplinary approach to sustainability planning.
To get started with the Business Case Tool, we recommend following these steps:
1. Select a multidisciplinary planning team.
This includes, at a minimum, the chief financial officer, analyst, clinical representative from care management, medical director or chief medical offer, and an operations lead.
2. Create shared understanding.
The team should align around revenue streams for CHCs in California, including APM 2.0, and how you plan to use the Business Case Tool. For more information, please see the Summary of California CHC Revenue Streams.
3. Discuss the implications of the CHC’s current decision regarding participation in APM 2.0.
- Identify if the health center is planning to: Stay fee-for-service for the foreseeable future.
- Stay fee-for-service for now, but plan long-term to move to APM 2.0.
- Adopt APM 2.0 early.
For context, note that opting to continue in a fee-for-service environment rewards improvement in population health by increasing billable visits through:
- Engaging a higher percentage of the assigned Medicaid membership to become active patients.
- Increasing the percentage of primary care and behavioral health visits delivered by the assigned health center.
- Closing gaps in care.
- Improving management of chronic conditions.
- Quickly addressing acute change in health status.
Under the fee-for-service financial structure, existing and expanded care team members are assigned duties that allow the billable member of the care team to concentrate their efforts on visit tasks that they are uniquely qualified to perform.
Alternatively, electing to participate in APM 2.0 rewards a care team for attracting and managing a larger panel of assigned members through the most efficient, yet clinically appropriate, use of the full care team. In this financial model, existing and expanded care team members assume clinical responsibilities within their scope of training and license, and only complete a warm handoff to a billable member of the care team if clinically required.
For example, adding nurse triage in a fee-for-service environment might add cost (salary and benefits) without corresponding revenue to offset the cost, such as billable visits. Alternatively, adding nurse triage in a capitated environment might add cost (salary and benefits) but creates the ability to manage a larger panel size, enhancing financial sustainability.