OVERVIEW

An Opportunity to Deliver Even Better Quality Care

Flexibility. Assurance. Consistency. All of these concepts are at the core of the payment reform demonstration.

Our pursuit of this reality began in 2011 when we began researching the best method to utilize an alternative payment methodology. CPCA’s Board of Directors tasked staff to develop a payment reform proposal that would ensure health centers have the flexibility to provide care in the most appropriate manner to patients while still maintaining the necessary resources. Attempts at a legislation began in 2014, and were ultimately successful in 2015 with the passage of Senate Bill 147, authored by Senator Hernandez.  SB 147 authorizes a pilot program where health centers will receive a PPS-equivalent per member per month rate for sites that they volunteer to participate in the pilot. 

The payment reform methodology converts a health center site’s current PPS rate to a per member, per month (PMPM) capitation payment that would be paid by their health plan(s) or IPA(s). CPCA anticipates the pilot will commence in 2017. To date, over 30 health center corporations have volunteered to have one or more of their sites in the Alternative Payment Methodology (APM) demonstration. With the PMPM capitation rate, health centers are free to determine how best to deliver care to their patients as the PPS rules [four walls restrictions, same day billing restrictions, and limits on which providers to utilize] will no longer constrain them.

With the inevitability of payment reform and the transition from an encounter-based payment system to one based on quality outcomes, it is important that CCHCs are engaged in innovative best practices in patient care delivery, information technology, data collection and analysis, and health center operations. This will in essence “transform” the way CCHCs provide care.

 

CURRENT ADVOCACY

CPCA convenes a Wrap Cap Workgroup primarily comprised of CPCA and CAPH members interested in participating in the voluntary demonstration on a monthly basis.  Additionally, CPCA will be conducting quarterly webinars for all members to provide updates on the Wrap Cap and the other payment reform work CPCA is engaged in.

Please contact Andie Patterson at andie@healthplusadvocates.org if you would like to participate in the Wrap Cap Workgroup.

 

RESOURCES

CPCA WrapCap Webinars:

January 18, 2017

Registration URL: https://attendee.gotowebinar.com/register/1075577837944566018

 

December 14, 2016

 

November 16, 2016

  • Cancelled 

 

October 19, 2016

 

September 21, 2016

 

August 17, 2016

  • Cancelled - no updates

 

July 20, 2016

 

June 15, 2016

 

May 25, 2016

 

March 16, 2016

 

February 17, 2016

 

January 20, 2016

  • Cancelled due to no APM or State Work Group activity given the holidays

 

CPCA Quarterly Payment Reform Webinar 

 

Tuesday, August 23, 2016

Tuesday, October 20, 2015

 

Staff Contacts

If you have any questions about the Wrap Cap or would like to be involved in the work, please contact Andie Patterson, Director of Government Affairs, at andie@healthplusadvocates.org.

 

 

 


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