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AHE Learning Collaborative Application

Informational Webinar

We will hold a 60-minute webinar describing the AHE Learning Collaborative in more detail. The webinar will include information about the application process and a question and answer session.

Date and time:
April 9, 2019
3:00-4:00 p.m. EDT
2:00-3:00 p.m. CDT
1:00-2:00 p.m. MDT
12:00-1:00 p.m. PDT

We require registration for the webinar. Click here to register. A recording and transcript of the webinar will be available on this website on approximately April 15, 2019.

The moral imperative to achieve health equity is clear. Partner with us to get there.

The Advancing Health Equity: Leading Care, Payment and System Transformation program (AHE) announces a Learning Collaborative for state Medicaid agencies, Medicaid Managed Care Organizations (MMCOs), and health care provider organizations or systems to align their equity goals and activities to eliminate disparities in health and healthcare. AHE is a program of the Robert Wood Johnson Foundation based at the University of Chicago, in partnership with the Institute for Medicaid Innovation (IMI) and the Center for Health Care Strategies (CHCS).

 

What is the AHE Learning Collaborative?

The AHE Learning Collaborative will offer technical assistance and capacity building services to state Medicaid agencies, Medicaid managed care organizations (MMCOs), and health care delivery organizations who agree to team up for this project. Each team will consist of representatives from a state Medicaid agency, a MMCO operating in that state, and two or more provider organizations or systems (e.g., health systems, hospitals, community health centers, private and individual practices and clinicians) contracted by the MMCO.

The Advancing Health Equity program will convene nine such teams together regularly over the course of two years to share experiences and lessons learned and to engage in peer-to-peer learning. The Learning Collaborative will help state Medicaid agencies, MMCOs, and health care delivery organizations to achieve their health equity goals by aligning their resources and strategies.

Each team will design integrated health care delivery and payment reforms to reduce health disparities and then implement these efforts at the participating healthcare delivery organizations. The Learning Collaborative will also generate best practice and policy recommendations for integrating payment and healthcare delivery reforms to advance health equity by eliminating health and healthcare disparities.

Technical Assistance Provided to Learning Collaborative Teams

The Learning Collaborative participants will receive in-person training (travel expenses covered by AHE for up to four persons from each Learning Collaborative team), web-based training, and tailored technical assistance that is designed to provide teams with the following:

  • Strategies for addressing common challenges when adopting quality improvement or health equity projects, including competing priorities, limited resources, identifying a return on investment (ROI), ensuring that quality of care is maintained and improved, state and federal policy barriers, and challenges with payer, hospital and clinician partnerships.
  • Tools and resources for incorporating equity into payment reform initiatives.
  • Skills and programs related to creating and sustaining equitable health care that they can use long after the program ends.
  • Peer-to-peer learning with other participants throughout the United States.
  • Technical assistance around using practice-level quality measures stratified by race, ethnicity, language, socioeconomic, or other demographic variables to inform their projects.
  • Support for improvements in clinical performance measures, associated composite measures (empirically derived measures that combine individual quality metrics, such as structure, process, and outcome indicators, into a single measure), and/or quality or cost goals.

Benefits of Participating in the AHE Learning Collaborative

Team participating in the Learning Collaborative will benefit from:

  • The potential to improve the quality of care and health outcomes for Medicaid enrollees who may be experiencing health disparities.
  • The opportunity to design and implement integrated equity-focused value-based payment and quality improvement efforts designed to reduce or eliminate disparities in health care outcomes.
  • The opportunity to collaborate with other key stakeholders (Medicaid Agencies, MMCOs, health care organizations and systems) on a shared initiative.
  • The ability to position themselves to take advantage of upcoming regulatory and federal mandates to improve quality and reduce disparities in health care outcomes.
  • Unique opportunity to be at the forefront of value based payment with unparalleled resources/support

Additional Benefits for Health Care Organizations and Systems

  • Ability to share learning with other health care providers in an open environment to test initiatives
  • Knowledge and skills to incorporate an equity focus into all quality improvement activities.

Additional Benefits for Medicaid Managed Care Organizations

  • Ability to collaborate with other MMCOs in an open environment to test initiatives.
  • Potential to position yourself strategically for state contracts by demonstrating involvement in an innovative value-based payment initiative includes provider and state collaboration.
  • Potential (depending on focus) to increase Healthcare Effectiveness Data and Information Set (HEDIS) and Early and Periodic Screening, Diagnostic and Treatment (EPSDT) interventions and results

Additional Benefits for State Medicaid Agencies

  • Unique opportunity to leverage existing value based payment approaches, with support for balancing quality and cost.
  • Ability to share learning with other Medicaid agencies testing initiatives that leverage value based payment to address equity and social determinants of health.

Request for Applications and Application Instructions

Request for Application
Please click here to download a pdf copy of the Request for Applications document. This document describes the goals of the program, lists the eligibility criteria and the application requirements, and provides application instructions.

Application Instructions
The application consists of the following:

    • Cover letter
      The cover letter does not have a required format and can be brief. It can be submitted on organization letterhead. At minimum, please indicate the organization partners and the main motivation(s) for the partners’ desires to participate in the Learning Collaborative. The letter should be submitted by the lead applicant organization as a PDF document.
    • Application questions and appendices
      The RFA contains six questions that each applicant team must answer. This question rubric document contains detailed information about each of the questions and guidance for answering them. Please utilize this Word template and the instructions within it to answer the six questions. Upload the template containing the question answers as a PDF document.
    • Background questionnaire
    • Readiness Assessment Questionnaires. Please have each partner organization complete this questionnaire.

Applicant teams should go to this link to submit each of the materials described above (cover letter, application questions and appendices, background questionnaire, and a Readiness Assessment Questionnaire for each partner organization.

Important Dates (Application Deadline May 24th at 3:00 pm CDT)

RFA Posted

March 25, 2019

TA Webinar

April 9, 2019
3:00-4:00 p.m. EDT
2:00-3:00 p.m. CDT
1:00-2:00 p.m. MDT
12:00-1:00 p.m. PDT

Application Deadline

May 24, 2019 by 3:00 p.m. CDT

Notification of Decision

June 28, 2019

Launch Meeting (Chicago)

October 2-3, 2019

Final Meeting (Chicago)

August 2021

Frequently Asked Questions

Click here to view a list of frequently asked questions (FAQs). The questions will be updated throughout the application period. Last updated 03/25/2019.

Reducing Health Care Disparities through Payment Reform

How can we deliver and pay for care in a way that reduces disparities? While much is now known about how to identify and reduce disparities via quality improvement, such programs are often under-resourced or not financially feasible for the long-term. Payment reform may be a potential solution, but reforms that do not explicitly consider disparities run the risk of unintentionally exacerbating or creating disparities.

In 2014, the Robert Wood Johnson Foundation (RWJF) funded Finding Answers to expand its focus to examine disparities interventions in the context of innovative ways to pay for care.

The Finding Answers: Payment Reform and Disparities program’s core goals were to:

  • Explore promising ways to reduce disparities by paying for care differently
  • Share practical lessons to inform other organizations who want to do similar work

Key Findings

The three grantee projects have now finished. From their results, Finding Answers has compiled comprehensive lessons learned to help other organizations as they combine payment reform and care delivery reform for optimal effectiveness in reducing health care disparities. You can read the lessons-learned here.

We also gathered our high-level findings and recommendations into a brief report. Among the key findings:

  • Designing and implementing effective financial incentives to reduce disparities has potential but is more complex than anticipated. There are many things other than money that healthcare teams find motivating and an incorrectly designed financial incentive system can discourage them. Financial incentives are also very challenging and information technology-intensive to implement. Integrated payment and delivery reforms to address disparities need to be tailored to the organizations and settings. There is no one-size-fits-all answer.
  • There are many benefits of team-level incentives. One of the advantages is that they can encourage integrated care management as team members strive toward a common goal.
  • Data management is critical. Revealing and combating health care disparities requires sustained collection, integration and reporting of race, ethnicity and language (REL) or other key demographic data. Updates on the status of a disparity and related quality of care measures may be more motivating to some health care team members than a financial incentive. 
  • Patient navigators and case workers (especially those who share language, identity, or heritage with a vulnerable group) can make a big difference in disparities—if their positions are funded. Flexible funding models and high-level commitment are necessary to ensure their success. Much work remains in changing policy and practice so that payers cover peer-based models.
  • Providers and other health care team members are usually surprised about disparities in their patient care. But once they find out, they are highly motivated to do something about it—whether or not you give them money.
  • Institutions, leaders, and individual team members must buy in. Policy change and value-based payment systems can encourage health care leaders to prioritize disparities reduction in a sustained way—and make it financially viable to do so. They can also incentivize the hard work of culture change necessary to address disparities.
  • Providers are motivated to reduce disparities. New financial models might make it more possible to do so, especially when aligned with state Medicaid programs and federal policies.

Our recommendations include:

  • In many cases, payment reform for equity initiatives must incentivize the organization as a whole, including its leaders and investors, not just the practitioners within the organization. Programs must be designed with in-depth knowledge of what organization leaders view as key metrics to monitor and measure that will inform and encourage long-term sustainability.
  • To help justify the organizational investments by providers, payer organizations—especially large payers such as state Medicare and Medicaid administrations—could prioritize disparities reduction in their requirements for health plans. Future efforts must explore ways to incorporate disparities-reduction guidelines without negative side effects (for example, they should not overly burden safety-net health systems).
  • Because there is no one answer that works to reduce all disparities, incentive systems should be flexible and allow for experimentation and rearranging the care system in whatever way is most effective.
  • At every level, improved data collection and management are necessary for the wider adoption of disparities-reduction efforts. 

Funded Pilot Projects

In this phase, Finding Answers managed three pilot projects working to achieve disparities reductions through a combination of payment and delivery reform. Click on the links below to explore our grantees’ work:

George Mason University, Virginia

Improving screening and disease management for diverse, multilingual patients at safety-net clinics in northern Virginia using team quality improvement incentives.

Icahn School of Medicine at Mount Sinai, New York

Ensuring postpartum care for Medicaid-covered, high-risk, mostly minority women in a New York City health system through physician incentives and coordinated care.

University of Washington, Oregon

Community-based oral health care for mothers and children in rural Oregon using expanded-practice dental hygienists, global budgeting and a team payment incentive.

National Program Office

Under the direction of Marshall H. Chin, MD, MPH, the national program office continues to contribute to national conversations about reducing disparities. See our News and Publications pages for the most up-to-date information and links to our work.