The Business Case Guide helps Community Health Centers and other primary care practices develop a financial strategy to support sustainable population health management. Designed for financial, clinical, and operational leaders, the guide centers on the PHMI Business Case Tool, an interactive financial modeling resource that helps organizations project costs and revenue, estimate return on investment (ROI), compare projected and actual financial performance, and make data-informed decisions throughout implementation. The guide includes adaptations for federally qualified health centers (FQHCs), addressing patient and payer mix, community health center revenue streams, payment mechanisms, budgeting, care team staffing, and operational planning. It supports organizations in evaluating financial sustainability before implementation and monitoring financial outcomes over time.
The guide promotes a multidisciplinary approach to sustainability planning by bringing together finance, clinical, operational, quality improvement, and organizational leadership to develop and refine business cases for population health initiatives. Topics include financial projections, scenario planning, resource allocation, care team expansion, implementation planning, value-based care, value-based payment, alternative payment models (APMs), capitation, shared savings, fee-for-service, pay-for-performance, California Alternative Payment Methodology (APM), Enhanced Care Management (ECM), prospective payment system (PPS), revenue streams, community health workers, health equity, social risk adjustment, telehealth, health information exchange, population data management, and strategies for scaling successful models across clinical sites. Additional content explores payment reform, CalAIM, long-term sustainability, and emerging opportunities in population-based and value-based care.