Quick Finds: Value-Based Health Care Transformation

How to Use Population Health Tools to Stratify Your Population for Care Management (2024). Resource Type: Archived Webinar. Description: This webinar demonstrates how to use population health electronic tools to identify patients with chronic illnesses with an obesity (or elevated BMI) comorbidity. Having this information allows health centers to identify the patients who would benefit from care management, additional resources, and care coordination services. More Details...

Clinical Workforce Development Fall 2023 Webinar Repository: English and Spanish Versions Available (2024). Resource Type: Publication. Description: The following publications present a summary of the NTTAP Fall 2023 activities and findings from an analysis of activities presenting relevant and pertinent information on clinical workforce development More Details...

Quality Improvement Strategies for LTBI Prevention and Care in A/AA and NH/PI-Serving Health Centers: National Clinical Quality Measurement - January 2024 (2024). Resource Type: Publication. Description: AAPCHO and the Tuberculosis Elimination Alliance held a learning collaborative, funded by the Centers for Disease Control & Prevention and the Health Resources & Services Administration, in April 2023. More Details...

Using PCMH to Improve Asthma Outcomes Webinar (2024). Resource Type: Archived Webinar. Description: The training reviews the practice of using a team approach to manage pediatric patients with asthma, engaging pediatric patients with care management, and exploring appropriate treatment options for asthma. More Details...

The Health of Asian Americans, Native Hawaiians, and Pacific Islanders Served at Health Centers: An Analysis of the 2021 Uniform Data System (2023). Resource Type: Publication. Description: This report examines current patient demographics and utilization of health services at health centers serving Asian Americans (AAs) and Native Hawaiians and Pacific Islanders (NH/PIs), and highlights the differences between these centers and the national average of all health centers in the United States. The analyses presented throughout this report are intended to improve understanding of AA and NH/PI patients served by health centers nationwide. More Details...

Successful Steps for Holistic Integration of Mental and Behavioral Health in Primary Care Learning Collaborative: Part Four (2023). Resource Type: In-Person Training. Description: Session 4 or 4 delves into various quality improvement techniques. Participants learned how to apply the Plan-Do-Study-Act (PDSA) cycle effectively to bring about meaningful change within their healthcare settings. Practical tools and real-world examples guided participants in identifying areas for improvement and implementing evidence-based strategies. More Details...

Implementing Nurse Practitioner (NP) and NP/Physician Associate (PA) Postgraduate Training Programs: Program Development, Recruitment Strategies, and Accreditation (2023). Resource Type: Archived Webinar. Description: Join us and our peers at Open Door Community Health Centers as we dive into the key elements of successful primary care NP/PA residency programs. Discover program structure, recruitment strategies, bias reduction techniques, and the accreditation process. By the end of this webinar, you\'ll gain insights to implement and sustain effective NP/PA residency programs and enhance your clinical workforce development approach. More Details...

Successful Steps for Holistic Integration of Mental and Behavioral Health in Primary Care Learning Collaborative: Part Three (2023). Resource Type: Online Self-Paced Learning Modules. Description: Integrating behavioral health services into primary care requires effective financial planning and re-conceptualization of determining ROI. Session 3 of 4 focuses on enhanced billing practices tailored to integrated healthcare models and on determining the contribution of integrated BH to the finances of the primary care setting or the health system as a whole. More Details...

Enhancing Healthcare Access for Special Populations Through Telehealth and Home Visitation Services: Part Two (2023). Resource Type: In-Person Training. Description: Hosted by the National Nurse-led Care Consortium and the National Center for Health in Public Housing, this 2-part webinar series discussed promising practices in home visitation and telehealth as ways to support improved access to comprehensive primary care for communities with high levels of disability and isolation, lack of adequate transportation, and other social drivers of health that contribute to health inequities, particularly residents of public housing. More Details...

Successful Steps for Holistic Integration of Mental and Behavioral Health in Primary Care Learning Collaborative: Part Two (2023). Resource Type: Online Self-Paced Learning Modules. Description: Session two focused on enhancing understanding of integrated care models and aspects of gaining leadership support for successful implementation. Leadership endorsement is critical for the successful implementation of integrated care methods. Participants engaged in discussions centered around strategies to gain leadership buy-in. Case analyses and group exercises empowered attendees to identify key motivators for leaders and tailor their approach to effectively communicate the benefits of integrated care, thereby securing the necessary support. More Details...

Successful Steps for Holistic Integration of Mental and Behavioral Health in Primary Care Learning Collaborative: Part One (2023). Resource Type: In-Person Training. Description: Integrated healthcare is a unique way to detect and address the broad spectrum of psychological, biological, and social needs among primary care patients. In part one of this learning collaborative, participants explored different levels of engagement and examined this framework of collaboration and the different levels of integration; we also learned about key strategies for successfully implementing integrated health care in your healthcare setting. Participants were introduced to the framework for patient and family engagement and reviewed an organizational assessment to gauge where action can be taken. More Details...

Managed Care Data Checklist: Companion Document to Video Module: Payer Data: The Managed Care Data. Prepared by Starling Advisors for the HITEQ Center in July 2022. (2023). Resource Type: Toolkit. Description: How to Use This Checklist: This is a supplement to our Module 2: The Managed Care Data Set, which uses the HCP-LAN APM Framework as its basis. Review both before using this checklist. There are terms used throughout that may be new to you or may benefit from detailed explanations—please visit our Value Based Payment Glossary for basic definitions for a host of key terms. More Details...

PrEP Process Map Example: HITEQ Center, September 2023 (2023). Resource Type: Toolkit. Description: This resource is an example of a Pre-Exposure Prophylaxis (PrEP) Process Map. A process map is a picture of how a health center workflow moves from the start point to the end point. As you review the process map, make note of the design elements, such as use of colors, shapes, and icons, and the level of detail included in the map. You can download the process map in the Documents to Download section below. More Details...

Interoperability Readiness Scorecard: HITEQ Center, July 2023 (2023). Resource Type: Template. Description: Many health centers struggle to reap the benefits of technological advancement and investments in health information technology (health IT), while others embrace them and reap rewards. Interoperability is one such example; requiring health centers assess systems, relationships, and implementation. There are keys to successful interoperability implementation for which health centers must develop processes, stand up infrastructure (within the system, internally and externally, and organization), and then take action. Process refers to structured processes, policies, and procedures within the health center. Infrastructure refers to structural capacity and ability within the health center’s technology and staffing structure. Action refers to full implementation to the point of active and ongoing use and engagement. This scorecard encourages health centers to consider their processes, infrastructure, and action in a number of key areas. Each area key to interoperability are to be self-graded on a scale of 1 through 5, where 1 is poorly or not yet developed and 5 is well developed. Health centers can also use this to guide discussions and monitor progress over time. evaluate once steps have been completed. More Details...

Health IT Optimization for Effective PrEP Services: HITEQ Center, June 2023 (2023). Resource Type: Toolkit. Description: Health centers are increasingly interested in embedding oral Pre-Exposure Prophylaxis (PrEP) programs into primary care, which calls for the embedding of PrEP care processes into electronic health record (EHR) systems. Health centers have had success with automation in HIV testing, and are looking to apply automated algorithms, order sets, and templates to the development of PrEP programs. This resource outlines EHR and health information technology (IT) configurations and tools that support PrEP care processes and provides examples of successful implementation from health centers and primary care settings. More Details...

NTTAP Webinar Series (Activity Session) - June 6, 2023: Using the RTAT to Assess Organizational Capacity (2023). Resource Type: Archived Webinar. Description: Improve educational training experiences at your health center by assessing your capacity and infrastructure to host health professions students. Join the upcoming hands-on interactive activity session to learn how to utilize the Readiness to Train Assessment Tool (RTAT). This tool was developed by HRSA-funded National Training and Technical Assistance Partners (NTTAP) at Community Health Center, Inc. (CHC) to understand organizational readiness to host health professions student training programs. More Details...

Social Determinants of Health Lessons Learned, Challenges, and Barriers: A Resource for Health Centers, Vol. 3 (2023). Resource Type: Publication. Description: The Association of Asian Pacific Community Health Organizations (AAPCHO), Health Outreach Partners (HOP), MHP Salud, and National Health Care for the Homeless Council (NHCHC), four HRSA-funded National Training and Technical Assistance Partner organizations, released a report on lessons learned, challenges, barriers, and impact stories shared from the (4) sessions of the “Acting on SDOH Screening Data to Address Barriers to Health” Learning Collaborative. This Learning Collaborative shared strategies to respond to SDOH data through enabling services staff, culturally and socially appropriate interventions, and internal and external organizational capacity. More Details...

NTTAP Webinar Series - May 2, 2023: Health Professions Student Training Webinar: Assessing Organizational Capacity (2023). Resource Type: Archived Webinar. Description: In order to provide a high-quality educational training experience at your health center, Community Health Center, Inc. (CHC) recommends assessing your capacity and infrastructure to effectively host health professions students. In the midst of competing priorities, best practices and tools will support this strategic workforce planning. Along with these best practices, panelists will discuss faculty’s roles and responsibilities, as well as hear directly from CHC staff. Additionally, this webinar will introduce the Readiness to Train Assessment Tool (RTAT™), a tool developed by HRSA-funded National Training and Technical Assistance Partners (NTTAP) at CHC to better understand organizational readiness to host health professions student training programs. More Details...

The Managed Care Data Set - Video: Developed with Starling Advisors in 2022 (2023). Resource Type: E-Learning. Description: This is the second in a three module value based care basics series from the HITEQ Center. This module was developed by Starling Advisors in 2022. More Details...

Health Centers Serving Veterans: Learn about the New PACT Health Benefits (2023). Resource Type: Archived Webinar . Description: This national audience webinar will provide health center administrators and provider teams with the most recent information regarding new health and service benefits passed by Congress in 2022, to be implemented by the US Dept. of Veterans Affairs. Specifically, the PACT webinar will explain the toxic exposure criterion and how health centers can screen and/or refer Military Veterans for the new benefits they've earned and deserve. More Details...

Implementation of Timely and Effective Transitional Care Management Processes (2023). Resource Type: Archived Webinar. Description: Join us to discuss best practices for integrating daily follow-ups for patients recently hospitalized for health emergencies. Effectively following up with patients is a critical responsibility for integrated care teams. More Details...

Specialty Care Access in Health Centers - What is the Potential of eConsults?: HITEQ Highlights Webinar (2023). Resource Type: Archived Webinar. Description: Access to care is the essential work of health centers, and one pain point is how to ensure specialty access for health center patients. This webinar will discuss innovation in specialty care access using technology and e-Consults. Electronic consultations (“e-consults”) are asynchronous, consultative, provider-to-provider communications within a shared electronic health record (EHR) or web-based platform. E-consults are intended to improve access to specialty expertise for patients and providers without the need for a face-to-face visit. More Details...

HITEQ Highlights: What You Need to Know About Managing Data in Value Based Care Contracts: HITEQ Highlights Webinar (2023). Resource Type: Archived Webinar. Description: This webinar will feature a panel of leaders in the health center world of value based care discussing how data can be managed and leveraged as a strategic asset. As value based care, alternative payment models, and managed care arrangements are becoming more common for health centers, health centers are called on to increase their knowledge and action in this area. Join us to hear from experts and pose any questions you have! More Details...

Implement Behavioral Health Training Programs to Address a Crucial National Shortage in Community Health Care Settings (2023). Resource Type: Archived Webinar. Description: Health centers are uniquely positioned to address the unprecedented need for behavioral health services but are challenged by the workforce shortage. Participants will gain the knowledge needed to begin conceptualization of a training pathway. Join us to discuss the considerations of sponsoring an in-house training program across all educational levels, including the benefits, program structure, design, curriculum, supervisors\' role, and required resources. Experts will provide participants with examples from practicum and postdoctoral level training programs to help them gain confidence in developing a behavioral health training pathway. More Details...

SDOH Screening & Referrals to Support Diabetes Control: Screening & Coding, Care Team Optimization, Referrals to the Community & Closing the Loop (2023). Resource Type: Archived Webinar. Description: In this three-part webinar series hosted by the National Nurse-led Care Consortium (NNCC), participants can expect to learn about the importance of SDOH screenings and whole-person wellness to improve diabetes management and outcomes. Presenters will share their knowledge of executing patient centered SDOH screening tools and referrals to support services while managing diabetes. This series will discuss implementing best practices for patient-centered approaches to care by utilizing SDOH screening and care team optimization and coordination. More Details...

NTTAP Webinar Series - December 12, 2022: HIV Prevention: Combating PrEP Implementation Challenges (2022). Resource Type: Archived Webinar. Description: Expert faculty present case-based scenarios illustrating common challenges to integrating HIV PrEP in primary care. As part of improving clinical workforce development, this session will delve into a variety of specific PrEP implementation challenges. Participants will leave with strategies to overcome these obstacles to establish or strengthen their PrEP program. More Details...

Advancing Team-Based Care: Enhancing the Role of the Medical Assistant and Nurse through Implementation of Care Management to Improve Chronic Conditions (2022). Resource Type: Archived Webinar. Description: Expert faculty outline the differences between case management, care coordination and complex care management to frame up a discussion on strategies to leverage effective models for both in-person and remote services. Expert faculty discuss the role of the medical assistant and the nurse in care management, as well as how standing orders and delegated orders support this work. This session will discuss how telehealth and remote patient monitoring enhancements can support complex care management for patients with chronic conditions. Participants leave this session with the knowledge and tools to begin or enhance implementation of chronic care management by enhancing the role of the medical assistant, nurse and the technology that supports the clinical care. More Details...

Partnership for the Future: Health Centers and Maternal Child Health Home Visiting Opportunities (2022). Resource Type: Publication. Description: The National Nurse-Led Care Consortium (NNCC) has developed a publication on Maternal, Infant, and Early Childhood Home Visiting (MIECHV) funded home visiting programs working in partnership with health centers. The publication outlines key steps and resources for integrating MIECHV programs and health centers and provides examples of successful collaborations. More Details...

Nurse-Led Health Care and Health Centers (2022). Resource Type: Publication. Description: The National Nurse-Led Care Consortium (NNCC) has developed a brief discussing opportunities for health centers to optimize recent increases in the nurse practitioner (NP) workforce across health centers. The brief provides a comprehensive overview of nurse-managed health centers and highlights the role of nurse-led care on improved provision of primary care. More Details...

How Compassion and Relationships Reduce Chronic Stress (2022). Resource Type: Podcast. Description: The National Nurse-Led Care Consortium (NNCC) invites you to listen to the first episode of their Fall podcast series. Join them in reflecting on how compassion and relationships can mitigate the negative health impacts of chronic stressors. More Details...

Managed Care Data Checklist: Companion Document to Video Module: Payer Data: The Managed Care Data (2022). Resource Type: Toolkit. Description: This checklist will walk you, the health center, through a series of common considerations for contracts you may receive from payers with a specific focus on contracts that include value-based payment components. This document assists organizations in understanding the necessary data and data-related tools for managing population health within a managed care environment. More Details...

CalAIM: Major Components and Current Implementation Status (2022). Resource Type: Archived Webinar. Description: This webinar reviews the major components of the California Advancing and Innovating Medi-Cal (CalAIM) initiatives, including: Enhanced Care Management, Community Supports, Behavioral Health (Criteria to Access Specialty Mental Health and No Wrong Door), and the Population Health Management Strategy and Roadmap. Presenters will provide an overview of the initiatives, timeline, and strategic implications for health centers. This conversation is meant to be a high-level overview of the most impactful initiatives to health centers. More Details...

“Acting on Social Determinants of Health Screening Data to Address Barriers to Health” Webinar (2022). Resource Type: Archived Webinar. Description: AAPCHO, Health Outreach Partners (HOP), MHP Salud, and National Health Care for the Homeless Council (NHCHC) hosted a HRSA-sponsored webinar to explore strategies to screen special and vulnerable populations for social determinants of health (SDOH) and build effective practices to begin addressing SDOH through outreach and enabling services (ES). More Details...

Bright Spots in HIV Screening: Health center examples, developed June 2022 (2022). Resource Type: Publication. Description: Since 2020, health centers have reported the HIV Screening clinical quality measure on Table 6B of the UDS. This measures the portion of medical patients aged 15 through 65 who have at least one HIV test recorded between their 15th and 66th birthday. HITEQ hosted discussions with health centers in fall of 2021 to find out how they have made progress on this particular clinical quality measure. More Details...

Increasing Health Care Enrollment for Survivors of Domestic Violence (2022). Resource Type: Toolkit. Description: People who have experienced intimate partner violence (IPV) have unique health care needs, making insurance that covers comprehensive medical and behavioral health benefits all the more critical. Community health centers play an important role in helping survivors enroll in coverage and receive quality primary health and oral health care services. A special enrollment period for survivors makes enrollment possible across the year with additional provisions to make coverage more affordable for survivors. Health Partners on IPV + Exploitation developed two resources to support health care enrollment for survivors of domestic violence. More Details...

Social Determinants of Health Lessons Learned, Challenges, and Barriers: A Resource for Health Centers, Vol. 2 (2022). Resource Type: Publication. Description: The Association of Asian Pacific Community Health Organizations (AAPCHO), Health Outreach Partners (HOP), MHP Salud, and National Health Care for the Homeless Council (NHCHC), four HRSA-funded National Training and Technical Assistance Partner organizations, released a report on lessons learned, challenges, barriers, and impact stories shared from the (4) sessions of the “Screening Methods and Strategies for Using Data on Outreach and Enabling Services to Address Social Determinants of Health” Learning Collaborative. This Learning Collaborative explored strategies to screen special and vulnerable populations for social determinants of health (SDOH) and successfully utilize data to build effective practices to begin addressing SDOH through outreach and enabling services. With these lessons learned, AAPCHO, HOP, MHP Salud, and NHCHC will continue this work with a webinar and successive learning collaborative in 2022-2023. More Details...

Value Based Payment Contract Review Checklist for FQHCs: Checklist for FQHCs reviewing contracts, as a supplement to video module. Developed in 2022. (2022). Resource Type: Other. Description: The checklist, which can be downloaded below, will walk you through a series of common considerations for contracts you may receive from payers, with a specific focus on contracts that include value-based payment components. More Details...

Eyes on Access: Introduction to Comprehensive Vision Services in Health Centers (2022). Resource Type: Archived Webinar. Description: This is a Part 1 archive of a 2-part webinar series in Spring 2022 that reviewed the interconnection of vision, chronic disease and quality of life. Data substantiating community needs, disparities and barriers was reviewed. This webinar series addresses how health centers can integrate vision services into primary care. More Details...

Mobile Clinic Licensing 101 (2022). Resource Type: Archived Webinar. Description: CPCA hosted a webinar training session for licensing a mobile clinic on April 25, 2022. This webinar provides an overview of the following: o Mobile Clinic Definitions o Licensing requirements for a mobile clinic operated by a Primary Care Clinic in California as enforced by the California Department of Public Health (CDPH) o What to expect once you have applied for licensure o Who to contact for updates on the status of your application o Additional considerations, requirements, and best practices for operating a mobile clinic More Details...

Addressing Health Care Challenges for Migrant Farmworkers (2022). Resource Type: Archived Webinar. Description: Today in the Golden State, farmworkers encounter numerous risks to their health and increased barriers to care before, during, and after migration. Health centers play a crucial role in addressing disparities in accessing COVID-19 services, education, and resources in special and vulnerable communities. Health centers that serve migrant farmworker and their families face unique challenges. Mobility results in poor continuity of care, and the health issues that fact migrant farmworkers and other mobile underserved populations are often magnified or compounded by their migratory lifestyle. In this webinar, we provide examples, tools, and best practices to help health centers better integrate health center teams (e.g., providers and community health workers) and external partnerships (e.g., community-based organizations and local government). More Details...

Trends in Community Health Center Design (2022). Resource Type: Publication. Description: As we develop facilities that strengthen the work of our teams and facilitate improved outcomes for our patients, we are called to not only replicate past successes but to explore new ideas. Before you begin your next capital project, it is helpful to consider how your health center peers are responding to these common challenges. More Details...

Healing-Centered Approaches to Addressing Adolescent Relationship Abuse and Trafficking (2022). Resource Type: Archived Webinar. Description: School-based health providers can play an important role in promoting healthy relationships among adolescents. This webinar, co-hosted by the School-Based Health Alliance and Health Partners on IPV and Exploitation, will offer strategies for talking about relationship abuse and trafficking with adolescent patients in school-based health settings. Presenters will also share ideas for collaborating with community resources and partnering with youth to prevent violence and promote healthy relationships. More Details...

Developing a Postdoctoral Psychology Residency Program in Your Community Health Center (2022). Resource Type: Archived Webinar. Description: Two years later, we continue to witness the pandemic’s toll on mental health – and a sustained increased demand for mental health services. Behavioral health care providers who are experienced in integrated care settings are needed now more than ever. Join this webinar to learn how your health center can establish its own postdoctoral clinical psychology residency program. This webinar will address considerations such as program structure, design, curriculum, the supervisor’s role, required resources, and the benefits of sponsoring an in-house formal postdoctoral clinical psychology residency training program. More Details...

Building the Case for Implementing Postgraduate NP Residency and NP/PA Training Programs (2021). Resource Type: Archived Webinar. Description: Join us as we discuss the the drivers and processes of implementing a postgraduate nurse practitioner residency program at your health center, the benefits of implementing a postgraduate residency program, and the residency tracks for Family, Psychiatric/Mental Health, Pediatric, and Adult-Gerontology Nurse Practitioners. We are joined by Charise Corsino, Program Director of the Nurse Practitioner Residency Program, and Nicole Seagriff, Clinical Program Director of the Primary Care Nurse Practitioner Residency Program, from the Community Health Center Inc. More Details...

Successful Practices in Accountable Care Series: Numbers 1-24 (2021). Resource Type: Publication. Description: This publication combines individual documents in the Successful Practices in Accountable Care series, which ran from 2016-2020. The volume includes case studies from successful organizations, as well as discussions of focus areas. More Details...

Fundamentals of Comprehensive Care (2021). Resource Type: Archived Webinar. Description: Join us as we discuss the core concepts of team-based care and introduce elements of team-based care that builds upon these basics to support your teams in advancing their capability to provide satisfying and effective care to complex patient populations. We are joined by Margaret Flinter, Senior Vice President/Clinical Director for Community Health Center, Inc., and both Thomas Bodenheimer, MD, Physician and Founding Director, and Rachel Willard Grace, Director, from the Center for Excellence in Primary Care. More Details...

The Value Transformation Framework: Applied to Diabetes Control in Federally Qualified Health Centers (2021). Resource Type: Publication. Description: Diabetes and pre-diabetes impact more than 114 million Americans. Federally qualified health centers (FQHCs) provide care to some of the most high-risk and underinsured individuals throughout the US, twenty-one percent of whom report being told they have diabetes, compared to 11% of the general adult population. It is widely agreed our health care system requires a transformation to effectively address diabetes and its complications. More Details...

Using American Rescue Plan Act (ARPA) Funds to Build Health Center Value Based Payment (VBP) Capability (2021). Resource Type: Publication. Description: This document provides guidance on ways that FQHCs can utilize American Rescue Plan Act funds to develop and expand their VBP capabilities. Areas of focus for short-term investments include improving data and IT, integrating services, and improving access and health equity. More Details...

Just Breathe (2021). Resource Type: Publication. Description: This collection of wellness and recovery resources has been designed for survivors of domestic violence to track their progress and develop techniques for calming oneself and moving forward in the healing process. More Details...

Approaches to Financing Medical Respite/Recuperative Care Programs (2021). Resource Type: Publication. Description: Also known as recuperative care, medical respite care is short-term care for individuals experiencing homelessness who are too frail to recover from illness or injury on the streets or in shelters but not sick enough to remain in the hospital. This white paper describes trends and opportunities for funding medical respite programs and services and offers methods to expand and scale programs through innovative financing mechanisms and increased flexibility in payment policy. The paper outlines various approaches to finance medical respite programs, offering providers, state and federal Medicaid leadership, policymakers, and managed care organizations (MCOs) specific partnership options to ensure continuity and quality of care for patients with long-term health and housing needs. More Details...