Value-Based Care Enrollment Form

Streamline Value-Based Care Enrollment with Paperform

Value-based care is transforming healthcare delivery by focusing on patient outcomes rather than service volume. This Value-Based Care Enrollment Form helps healthcare providers, medical practices, and accountable care organizations efficiently enroll patients in coordinated care programs while tracking quality measures and managing chronic conditions.

Built for Modern Healthcare Workflows

This template is designed for healthcare administrators, care coordinators, and medical practices transitioning to value-based payment models. Capture comprehensive patient information, assess chronic conditions, identify care needs, and establish shared savings participation agreements—all in one streamlined form.

The form includes sections for patient demographics, insurance verification, chronic condition screening, care coordination preferences, quality measure baselines, and program consent. With conditional logic, you can tailor the enrollment experience based on specific conditions and care needs.

Enhanced with Automation Tools

Paperform integrates seamlessly with your existing healthcare systems. Connect submissions to your EHR, patient management software, or CRM to automatically create care plans and trigger follow-up workflows. Use Stepper to automate post-enrollment tasks like scheduling care coordinator consultations, sending welcome packets, assigning care teams, and setting up medication reconciliation appointments.

For practices requiring signed participation agreements, Papersign enables you to convert form submissions into legally binding eSignature documents, ensuring compliant enrollment while maintaining a complete digital audit trail.

Professional, HIPAA-Aware Design

This template balances comprehensive data collection with user-friendly design. The multi-page format breaks complex enrollment into manageable sections, reducing patient overwhelm while ensuring complete information capture. Customize the theme, add your practice branding, and adjust questions to match your specific value-based care model.

Whether you're launching an accountable care organization, implementing chronic care management programs, or participating in Medicare Shared Savings initiatives, this template provides the foundation for effective patient enrollment and care coordination.