The CAPC Payment Accelerator: A Joint Virtual Workshop for Home-Based Care Teams-CAPC Opportunity Assessment Worksheet

CAPC Opportunity Assessment Worksheet

Pdf Summary

The Brief Opportunity Assessment Worksheet provides a structured approach for programs seeking to contract with health plans or other risk-bearing organizations. It aids in identifying and understanding potential partners within the local healthcare landscape. The worksheet is divided into several key sections:<br /><br />1. **Local Health Plans:** This section prompts users to list the health plans operating in their area, including Medicare Advantage Plans, Special Needs Plans, Medicaid Managed Care Plans, and Commercial Health Plans. Resources are provided to locate these plans online.<br /><br />2. **Current Payer Mix of Your Program:** Users are instructed to review their program’s patients' primary health insurance over the past one to two years. This helps identify the top health plans the program frequently interacts with, making them potential candidates for pilot value-based payment arrangements.<br /><br />3. **Referral Sources:** By sorting patients by their referral source from the past one to two years, programs can determine their top 3-5 referral sources, aiding in better understanding and strengthening these relationships.<br /><br />4. **Existing Relationships:** This section encourages the identification of strategic or business partnerships outside referral sources. It asks for details on each relationship, including how the program can meet the partners' needs and add value.<br /><br />5. **Health Systems:** Users are asked to identify major health systems and provider groups in their region. This involves reviewing how these entities currently support seriously ill patients and determining how the user’s program can complement or supplement existing services.<br /><br />6. **Other Entities Who May Benefit from a Financial Relationship:** Programs are urged to explore potential partnerships with hospitals and other entities that may see improved performance through collaboration. This includes looking into those with specific metrics like Medicare re-admission penalties or high complaint rates.<br /><br />Overall, this worksheet serves as a comprehensive tool for mapping out potential collaborative opportunities and strategically positioning a program within the healthcare ecosystem.

Keywords

health plans

risk-bearing organizations

local healthcare landscape

payer mix

referral sources

existing relationships

health systems

provider groups

financial relationships

collaborative opportunities