Clinic Application

Thank you for your interest in becoming a pilot clinic for the Roadmap to Health Equity!
 
By submitting this application, you are agreeing that, if selected, your clinic will submit 1) clinic information, 2) sociodemographic (SDH) factors, and 3) clinic- and patient-level process and outcome quality measure data into the first national free and charitable clinic data repository for a minimum of 12 months. Please review the SDH factors and the quality measures here that will be reported into the repository.

VisionTree Optimal Care (VTOCTM) is the vendor that was selected for the data repository. Please find here the proposal from VisionTree explaining the FCC repository. VisionTree was selected by the How Committee and approved by the Steering Committee following a competitive discovery, presentation and scoring period. VisionTree is highly experienced in solutions to collect and track patient outcomes and improve care; it was determined by your FCC peers that this vendor understands the FCC sector. It is acknowledged that clinics will have additional questions about data submission into the repository all of which will be addressed during the on-boarding process with VisionTree. Click here to view the Master Software License Agreement.  
 
Please review this Additional Information for Clinic and Staff Eligibility Requirements and a very high-level look at how clinics will submit data before proceeding with submitting your application.
 
Key Dates
  1. This Application must be completed by September 13th, 2019.
  2. Clinics will be notified if they have or have not been selected by October 5th, 2019.
  3. Selected clinics must confirm their participation by October 15th, 2019. 
  4. Clinics will sign licensing agreements with Vision Tree and partner agreements with Americares by October 31st, 2019.*
* Americares is fully covering the per clinic start-up, one-time repository cost of $500 and the per clinic annual license fee of $750 for the first 2 years (24 months) of the VisionTree repository usage. The Roadmap to Health Equity Fundraising Committee is working to obtain additional funding to continue covering the annual fee of $750 for pilot clinics for the 3rd year of the VisionTree repository usage.  Clinics will have the option to opt-into paying for the $750 annual VisionTree license when funding ends - the timing of clinics covering their own $750 annual license fee is dependent upon funding.

BILLING WILL NOT BE TRANSFERRED TO PARTICIPATING CLINICS WITHOUT SIGNED CLINIC CONSENT.

As an additional thank you to clinics for their participation in Roadmap, clinics submitting data will be awarded a $1,000 stipend from Americares.
 
Questions about the application? Contact Taylor Joyner at tjoyner@americares.org.

Click here to access a PDF version of the application.

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