Partnering to Succeed: How Small Health Centers Can Improve Care and Thrive under Value-Based Payment

In California, CHCs serve more than 4 million people annually. Many CHCs in California and nationally are experimenting with strategies to improve and expand care, such as finding ways to integrate behavioral health, bolster team-based care, and proactively reach out to patients with unmet preventive or chronic care needs. In tandem, health centers are increasingly participating in value-based payment. These actions require consider­able infrastructure, with many components necessary for both endeavors. All health centers struggle to put this infrastructure in place, but small health centers — defined for the purposes of this paper as having fewer than 10,000 patients or an annual budget of $10 million or less — face unique challenges in securing access to capital, building strong data capabilities, and negotiating favorable rates with vendors and contracts with health plans.

To help clarify the way forward for small health centers, this paper presents a Model for Advancing High Performance (MAHP). Based on research and expert opinion, it describes the actions and infrastructure CHCs will need to thrive in this new environment and contribute to a sustainable primary care safety net that achieves the quintuple aim — better care, better health, lower costs, happier staff, and reduced health disparities.

As the MAHP shows, engaging in the actions required to achieve the quintuple aim necessitates supportive infrastructure in four major areas: people, care systems and strategies, data, and a business model. Infrastructure ele­ments such as meaningful patient engagement in care, well-defined patient panels, and the ability to create actionable data reports are important to support both care transformation and value-based payment.

For small health centers that are not in a position to cre­ate extensive infrastructure on their own, partnerships and alliances can be critical. When done well, such col­laborations can help health centers fulfill their missions by supporting and supplementing primary care activities to leverage resources and improve health. This paper presents sever types of partnerships, including partnerships with community based organizations, hospitals, consortia, MSOs and CINs, IPAs, health plans, and other health centers. Individual small health centers may make use of one or many of these partnerships depending on an array of fac­tors. This white paper provides a detailed review of these factors, along with the advantages and disadvantages of each partnership type, as well as concrete steps towards readiness for partnerships. In addition, four case studies highlight the experiences of small health centers partner­ing in these ways.

Partnering to Succeed: How Small Health Centers Can Improve Care and Thrive Under Value Based Payment was co-authored and published in collaboration with the MacColl Center for Health Care Innovation at Kaiser Permanente Research Institute Washington and the California Health Care Foundation.