Alternative Payment & Advanced Care Model

Overview

OPCA developed the Alternative Payment and Advanced Care Model to align payment and transform care and services to promote optimal health and health equity.

The standard payment mechanisms of the fee-for-service model in health care limits the ability of primary care teams to meet the real needs of patients. The limitations of a fee-for-service approach are especially severe in safety net health care settings, where the effects of poverty, trauma, stress and chronic disease require more care than a single, short visit with a provider can accomplish.

In partnership with Oregon community health centers and the Oregon Health Authority, OPCA developed the Alternative Payment and Advanced Care Model (APCM) to provide community health centers with the flexibility to not just deliver health care, but to foster health in the communities they serve. Oregon’s approach is the first Medicaid Alternative Payment Methodology (APM) for Federally Qualified Health Centers and Rural Health Clinics that has removed the incentive to produce face-to-face visits with a billable provider over a multi-year timeframe.

OPCA is also the first Primary Care Association to develop a robust Learning Community to facilitate health center care model change under a Medicaid APM. The APCM Learning Community promotes care model innovations that can be delivered outside of the medical encounter, with a strong emphasis on testing interventions that address the social risk factors that limit good health for patients served by community health centers.

Details

The payment model of APCM allows care teams to focus on patients instead of visits.

Under the APCM program, the fee-for-service Medicaid reimbursement for health centers is converted into a per-member, per-month payment. This capitated approach to payment gives community health centers the opportunity to tailor their care and services to the unique issues and circumstances of their patients, as well as to adjust where, how and what kind of care and services they provide. With this flexibility, health centers can focus on partnering with patients to create a plan for supporting better health.

With the latitude created by the alternative approach to payment, the APCM care model encourages care teams to address root causes of illness and well-being in the lives of their patients.

With revenue no longer directly tethered to the provision of individual medical encounters, community health centers can focus on developing a more effective approach to improving population health. The Social Determinants of Health are increasingly recognized as the critical drivers of health and well-being; APCM allows health centers to understand and respond to the non-medical circumstances that influence their patients’ health. Instead of reacting to episodic or emergent illnesses, teams treat the whole person, paying attention to their health as well as its economic, environmental, and social causes. The APCM model allows community health centers to focus on patients’ needs and priorities, which may be best addressed outside the examination room and even outside the walls of the clinic.

OPCA has been leading the development of APCM since 2010.

Since 2010, OPCA has been leading the development and implementation of the FQHC Alternative Payment Methodology (APM), in partnership with the State Medicaid office within the Oregon Health Authority. The APM program began with a pilot group of three clinics and has now grown to include 13 out of Oregon’s 32 Community Health Centers, along with one Rural Health Clinic. The first cohort of clinics went live on the new payment model in March of 2013.

After several years of development on payment transformation, OPCA created a collaborative learning community in 2013 to advance transformations in care, expanding APM to become the Advanced Payment and Care Model (APCM). The learning community was officially launched in early 2014 with a gathering of national experts and local safety net health care leaders to discuss the promising clinical practices available under a more flexible approach to payment. The learning community continues to meet several times a year to support participating clinics in care model transformation.