An Assessment of Community Health Centers' Implementation of Alternative Payment and Delivery System Reforms

Dates: 2014-2016

State: Massachusetts

Client(s): Blue Cross Blue Shield of Massachusetts Foundation

Services: Applied Research & Evaluation, Policy Development & Implementation

Technical Expertise: Health Care Reform, Integrated Care Models

Community health centers (CHCs), through their mission, structure, and target population, have a unique ability to benefit from the transformations brought about by Chapter 224 payment and delivery system reform. However, there are important gaps in the understanding of the implementation status and effects of payment reform on CHCs nationally and in Massachusetts. With the goal of reducing these gaps, Blue Cross Blue Shield of Massachusetts Foundation (BCBSMA) engaged JSI to assess Massachusetts CHCs’ current status and readiness to implement key components of reforms, as well as the barriers and facilitators to implementation. This understanding is critical in order for CHCs to be better informed and learn from their peers further along in the implementation process. Since the 2006 state reforms, CHCs have also played an increasingly important role in delivering primary care and other essential health services; therefore, this understanding will be essential for policymakers to adapt the PCPRI and the Medicaid ACO program to achieve the state’s cost goals, while preserving CHCs’ roles in promoting access and reducing disparities.

In order to understand the drivers and barriers to delivery system reform, JSI will review the financial incentives and structural requirements placed on provider groups. JSI will also conduct qualitative interviews and site visits with CHC staff involved in payment/delivery reform implementation on CHCs’ leadership and organizational structure; delivery system reform initiatives; payment arrangements; and data infrastructure. In order to analyze the extent to which reforms are associated with changes in CHCs’ costs and revenues, JSI will analyze data from the Bureau of Primary Health Care’s (BPHC) Uniform Data Set (UDS) on cost, revenue, workforce, patients, and other metrics. The goal of the project will be to prepare a Primer for the CHC audience, presenting a framework to understand their role in delivery system transformations and actionable steps to navigate the changing landscape.