Value-Based Care Delivery
We support Michigan health centers with value-based care delivery and payment models to promote higher quality, patient satisfaction at a lower total cost of care.
Michigan Community Health Network (MCHN)
The Michigan Community Health Network (MCHN) is a clinically integrated network formed by Michigan community health centers for the purpose of group contracting with Michigan Medicaid Health Plans. It was formed in 2015 and is owned by the Michigan Primary Care Association and 39 of its member health centers. MCHN negotiates value-based agreements on behalf of its members for the purpose of improving overall outcomes of the patients it serves and sharing in the resulting cost savings.
HIV Treatment and Prevention
The AIDS epidemic has taken an enormous toll since its discovery in the early 1980s. According to the latest available data, in 2019, 36,801 people received an HIV diagnosis in the United States. That annual number of new diagnoses has essentially remained stable since 2013. Worse, about 1 in 7 of the estimated 1.1 million people with HIV in the U.S. don’t know they have it. These data make clear that HIV prevention and treatment tools aren’t reaching the people who need them most.
Early Detection, Early Treatment Makes a Difference
MPCA has joined the Michigan Department of Health & Human Services to increase and routinize HIV testing at Michigan health centers. According to the Centers for Disease Control and Prevention, routine testing could reduce new HIV infections by more than 30 percent every year if all infected individuals learned their HIV status, received treatment or harm reduction, and addresses behavior patterns. Routinized testing can help increase diagnoses of HIV infection, destigmatize the testing process, link clinical care with prevention, and ensure immediate access to clinical care for persons with newly identified HIV infection. Plus, proper adherence to antiretroviral therapy can help people living with HIV achieve an undetectable viral load. When that occurs for at least six months, the risk of transferring the virus to a person who does not have it is negligible to nonexistent. In fact, nearly half of all people living with HIV in the United States cannot transmit HIV to any other person. Health care professionals refer to this state as “undetectable = untransmittable” (U=U).
Health Centers and Models of HIV Care
Michigan health centers receiving funding under the Ryan White Program provide a comprehensive continuum of outpatient HIV primary care services, including HIV counseling, testing, and referral; medical evaluation and clinical care; other primary care services; and referrals to other health services. In addition, the Health Resources and Services Administration recently unveiled a ten-year initiative beginning in FY 2020 with the goal of reducing new HIV infections to fewer than 3,000 per year by 2030. HRSA-funded health centers are a key entry point for people with HIV who are undiagnosed. Nearly two million patients annual receive an HIV test at a health center. You can learn more about Ending the HIV Epidemic here.
Value-Based Care and Payment
Value-Based Care and Payment is a movement toward redesigning our health care delivery and payment models to promote higher quality, patient satisfaction at a lower total cost of care. This shift away from volume-based payment models is a key step in achieving greater flexibility to deliver the most appropriate care to patients at a sustainable cost.
CINs, APMs, ACOs: What they are and how they fit with Value-Based Care.
This will provide definitions and a brief discussion of how each of these fit with VBC
Key Benefits and Considerations for Transitioning Care Models.
This will examine financial and operational considerations related to care models to support VBC
Population Health and Clinical Performance Improvement
Population health and clinical performance improvement are two pivotal focus areas for transforming health care that allows health centers to participate in value-based care and contracting. The association engages in initiatives and partnerships that support health centers in enhancing patient centered care. This enables the association to provide training and technical assistance to member health centers through networks, webinars, learning collaboratives, one-on-one support and other in-person events.
Population Health: Through strategic partnerships with state and national organizations, our Population Health team works with Community Health Centers across Michigan to improve health outcomes for the populations they serve. By leveraging data, health information technology, evidence-based interventions, and team-based care, we support initiatives focused on cardiovascular disease, diabetes, kidney disease, and colorectal cancer prevention and management. This work helps health centers identify patients at greatest risk, address non-medical factors impacting health, increase access to preventive screenings and services, and reduce health disparities while advancing high-quality, patient-centered care.
Clinical Performance Improvement: Clinical performance focus measures are chosen and updated by member health centers and include clinical, access and utilization measures.
Virtual Care
Virtual care encompasses the various ways healthcare providers can interact and engage with patients remotely. Common examples include telehealth and remote patient monitoring (RPM). Telehealth leverages information and communication technologies to enable providers to deliver healthcare services virtually, improving access to care and creating a more convenient, patient-centered experience for individuals who face geographic, transportation, or other access barriers.
MPCA supports its member health centers with the procurement, implementation, optimization, and sustainability of virtual care technologies through strategic partnerships, funding opportunities, and technical assistance.
Remote Patient Monitoring (RPM): MPCA previously secured grant funding and established strategic partnerships to expand RPM and virtual care services across Michigan’s community health centers. Through this previous FCC-funded initiative, nine health centers received RPM equipment and services, including Bluetooth-enabled blood pressure monitors, weight scales, and pulse oximeters, supporting enhanced patient monitoring and chronic disease management.
Today, MPCA partners with CAREMINDr, an innovative virtual care and patient engagement platform that extends beyond traditional RPM services. CAREMINDr supports chronic disease management, continuous patient engagement, remote monitoring, risk identification, and proactive care interventions. The platform offers solutions for conditions such as hypertension, diabetes, pregnancy, and behavioral health, enabling care teams to engage patients between visits, monitor health trends, and improve health outcomes through timely outreach and intervention. CAREMINDr combines patient-reported information, connected devices, and advanced analytics to support value-based care and population health initiatives.
Luma Health: MPCA’s Health Center Controlled Network has partnered with Luma Health, a patient outreach and engagement platform currently used by several member health centers. Luma Health enables organizations to communicate with patients through SMS text messaging, email, voice outreach, appointment reminders, and other engagement tools. Luma Health also offers telehealth capabilities and integrates with Azara to support targeted outreach based on care gaps, recalls, and population health initiatives.
Resources: For the most current tools, guidance, and best practices related to health information technology, virtual care, and data initiatives, members are encouraged to participate in MPCA’s Health Information Technology and Data online community.
Oral Health
MPCA provides dental teams with training and technical assistance to support their ability to provide high-quality care to the communities they serve. Additionally, we provide health centers with unique opportunities to innovate and lead the advancement of the dental field into the future. We partner with funders and other entities to align health center teams with programs related to integration, value-based care, population health and innovative workforce models.
Midwest Network for Oral Health Integration (MNOHI)
A four-state collaborative network between MPCA, Illinois Primary Health Care Association, Iowa Primary Care Association and Ohio Association of Community Health Centers. This project is being funded by HRSA beginning September 2019 and ending August 2024.
Dental Therapy Readiness Toolkit
Providers who are interested in offering Dental Therapy at their facilities can find resources on our Dental Therapy Readiness Toolkit.
Dental Careers
Explore dental careers in Michigan where you can change lives while working with a team that supports you — every step of the way.
Choose your path to learn more about dental therapy or explore all dental careers to find where you can make an impact.
Oral Health Value-Based Care
In a VBC delivery model, quality and outcomes improve while costs remain the same or fall because the healthier a person is, the less they require expensive services. A key driver in the success of a value-based system is aligning new payment models that reward care and outcomes and not the volume of services.
Adult Medicaid Restructure
Integrated Care
Integrated health care (interprofessional care, coordinated care, or collaborative care) is a whole-person approach to delivering coordinated mental and physical health — all in one setting. This model of care acknowledges that:
- Primary care settings, such as a doctor’s office, provide about half of all mental health care for common psychiatric disorders.
- Adults with serious mental illnesses and substance use disorders also have higher rates of chronic physical illnesses and die earlier than the general population.
- People with common physical health conditioans also have higher rates of mental health issues.
As a result, coordinating mental health, substance use, and primary services provides the best possible outcomes for people with multiple healthcare needs. Many of Michigan’s community health centers are working toward care integration, functioning as veritable one-stop shops for all their patients’ needs.
Integrated behavioral health care is the care a patient experiences as a result of a team of primary care and behavioral health clinicians, working together with patients and families, using a systematic and cost-effective approach to provide patient-centered care for a defined population. This care may address mental health and substance abuse conditions, health behaviors (including their contribution to chronic medical illnesses), life stressors and crises, stress-related physical symptoms, and ineffective patterns of health care. There are different levels of service integration and the Substance Abuse and Mental Health Service Administration (SAMHSA) designed a framework to help health care providers plan and support an integrated system.
Substance use disorder (SUD) negatively affects millions of people across the country. In fact, the Substance Abuse and Mental Health Services Administration’s National Survey on Drug Use and Health showed that 21.6 million Americans had an SUD in 2019, but only 12 percent of those who needed treatment received it. More than half of Michigan’s community health centers are providing some form of SUD treatment, and they’ve increased the number of providers who can prescribe medication-assisted treatment (MAT) to their patient population. These frontline health center employees have been trained on Screening Brief Intervention and Referral to Treatment, the American Society of Addiction Medicine Criteria, trauma-informed care, naloxone administration, and safe prescribing. Knowing that medication is one tool that can be used to treat substance use disorder, health centers have created integrated care teams that can treat the entire person.
Michigan Overdose Data to Action: Michigan Overdose Data to Action (MODA) is an initiative focused on supporting evidence-based overdose strategies through the use of data and by providing access to available training, resource and network supports. The purpose of the program is to strengthen and enhance the capacity of communities and health systems to prevent morbidity and mortality associated with opioid overdoses. The program is intentionally designed to bring surveillance teams and prevention teams together so that their work is more effective in decreasing rates of drug misuse, fatal and nonfatal drug overdose, and drug related ED visits. MODA funding has supported MPCA and members in building community partnerships to improve education and link patients to substance use disorder services and has funded health centers with purchasing of Azara technology focused on engaging providers and improving substance use disorder connections to care. MPCA is also in the second year of hosting a training series focused on SUD treatment with Mi-CCSI. The training series includes evidence-based clinical and operational topics and real life-examples from expert speakers.