Deciding

Questions to Consider Before Deciding to Participate

• How does my members’ benefit plan design work with HCH payment models?
• Are there changes to my benefits that could enhance member’s use of primary care and HCHs?
  • Do we cover e-visits, web visits or phone?
  • What is my member costs for care of chronic conditions?
• What percentage of my population has a primary care provider?
  • Do members have incentives to seek primary care first?
  • Do members have enough information to select a primary care provider if needed?
• What percentage of my population, has a chronic condition, is complex/high risk and could benefit from seeking care from a HCH?
  • How could those who would benefit the most receive the benefit of HCHs?
• What percentage of costs is paid to primary care providers, emergency rooms, hospital care, and specialists?
  • What would be the impact if I increased the amount paid to primary care by 20%?
  • What impact would that have on inappropriate care and its costs?
• What is my rate of “avoidable” and inappropriate emergency room visits and hospitalizations?