CIN Resource Page: Managing Total Cost of Care to Succeed in Risk-Based Payment

Reports and tools to support payers and providers

Payment models in California continue to evolve, with a strong trend toward moving more financial risk from purchasers and payers to provider organizations. These resources include information on the payment models in play in California and nationally, and case studies and expert advice on how to succeed in payment relationships that include financial risk.

Resources are organized reverse-chronologically and cover the following topics:

Alternative Payment Models and Frameworks

To engage in discussions about payment models, the first step is to understand the landscape: the business relationships, the different payment models, the terminology used, and the interventions that improve the quality of care and ensure financial success in these models.

  • Advancing Payment Innovation within Federally Qualified Health Centers: Lessons from California
    This white paper details best practices in the primary care safety net on a range of payment reform-related issues, including leadership engagement, change management, and financial management.
    (Center for Health Care Strategies, May 2017)
  • Success in Payment Reform Requires More and Better Data, Plus a Dose of Experimentation
    This report from the California Improvement Network meeting summarizes the discussion of current and anticipated alternative payment models in California, and success factors for each. This is a good starting point for orientation to payment models and the types of changes in population health management it supports.
    (California Improvement Network, April 2017)
  • APM Framework Fact Sheet
    The fact sheet explains the principles used in the 2017 refresh of this classification system for alternative payment models, and introduces the accompanying white paper, also available for download from the same webpage.
    (Health Care Payment Learning and Action Network, 2017)
  • NACHC Payment Reform Readiness Assessment Tool
    This assessment tool helps health centers understand their readiness for success in new payment models. This updated version incorporates social determinants of health and IT systems.
    (JSI, Inc., 2018)

Total Cost of Care

Population-based payment can support big changes in the organization of medical care and how care is managed. These resources focus on these opportunities and challenges, with a good mix of case studies from the commercial health care market and the safety net.