Oklahoma Chosen to Develop Value-Based Approaches to Medicaid Reimbursement for FQHC
Oklahoma has been selected as one of six states to participate in the National Academy for State Health Policy’s (NASHP) Value-Based Payment Reform Academy. The goal of this academy is to develop value-based alternative payment methodologies for federally qualified health centers (FQHCs) and rural health clinics (RHCs) that align with states’ goals for transforming how care is delivered.
NASHP is a 28-year old non-profit, non-partisan organization dedicated to working with states across branches and agencies to advance, accelerate and implement workable policy solutions that address major healthcare issues.
A joint application was submitted by the Oklahoma State Department of Health (OSDH), the Oklahoma Health Care Authority (OHCA), the Oklahoma Primary Care Association (OKPCA), representatives from two FQHCs (Variety Care, Inc., which is an urban-based FQHC and The Health & Wellness Center Stigler, Eufaula, Sallisaw and Checotah, which is a rural-based FQHC) and a representative of RHCs (Mercy Hospital Logan County). These core team members will receive technical assistance from the Policy Academy on cost-based, risk-adjusted reimbursement methodologies as it would apply to FQHCs and RHCS.
Unlike other providers, FQHCs and RHCs have no ability to manage risks through a reduced patient panel and cannot withdraw from Medicaid. Additionally, FQHC costs associated with delivering health care to uninsured individuals is much greater due to the many case management services involved (transportation, translation, health education/literacy, etc.) to address social determinants of health that have a severe impact on patient outcomes for the underserved population.
Core team members will receive support and access to expert consultation from national, federal, and state leaders as they analyze what an alternative payment methodology (APM) must include to sustain FQHC and RHC operations while enabling the achievement of the triple aim to lower costs, improve outcomes and enhancing patient experiences.
Participation in this Policy Academy complements the state’s recent efforts with a State Innovation Model (SIM) design grant. With the aid of this grant, the Oklahoma Health Improvement Plan Coalition, through OSDH, engaged a multitude of stakeholders to collaboratively develop a plan to transform the state’s healthcare payment and delivery system from a fee-for-service payment system to value-based payment system that emphasizes primary prevention strategies. Core team members of the Policy Academy played an instrumental role in the development of this State Health System Innovation Plan.