2023 Annual Report: Empowering community health centers through value-based care for a more sustainable future
Value Based Care
A message from Yuvo Health
Community health centers (CHCs) have never been more important. As we move into the post-pandemic environment where income inequality continues to widen, Medicaid upheaval is ongoing, and health disparities become ever more evident, CHCs are increasingly critical to the success and survival of some of our most vulnerable friends and family.
In rural and urban areas throughout America, there is an unprecedented need for the services that CHCs provide. Those services not only include high-quality preventive clinical and behavioral healthcare, but also the empathy, compassion, sense of safety, and cultural understanding that make a community health center the heart of their neighborhoods.
I know from personal experience, growing up in Detroit as a young immigrant from the Philippines, that CHCs change lives. Without accessible and affordable healthcare from the CHCs in the many places I lived as a child, my family wouldn’t have been able to build the life that made me who I am today.
But CHCs are struggling. They are underappreciated, under-resourced, and under the gun to find new ways to achieve sustainability in a rapidly changing financial and regulatory environment. As the pressure builds, CHCs need someone to support them in the same way they support the people they serve.
That’s what has led me back to CHCs once again: not as a patient, but as the CEO of Yuvo Health.
Yuvo Health is designed to care for the caregivers by eliminating barriers to participation in the exciting world of value-driven healthcare. Our mission is to unlock access to innovative financial models that reward CHCs for the exceptional care they already deliver – without the revenue risks that have traditionally kept health centers away from these opportunities.
We are proud to be changing the game for CHCs at a time when we simply cannot do without these essential care providers. In this first Annual Report, we invite you to learn more about value-based care for CHCs and see how our partners across the nation are leveraging these strategies to foster strong, sustainable communities of care in the places they call home.
Despite providing a vital safety net for these groups, CHCs face a number of challenges that threaten their very existence: from lack of physical space and the constant search for grant funding to issues with recruiting and retaining staff.
Value-based care offers something different for CHCs looking for a new way forward. By aligning reimbursements with quality instead of quantity, CHCs can turn their obstacles into opportunities and start to generate revenue from the holistic, person-focused activities that already define what it means to deliver community-based care.
In this annual report, CHCs partnering with Yuvo Health will share stories and data about how they are making value-based care work in even the most challenging of environments.
But first… exploring value-based care for community health centers
Value-based care (VBC) is the idea that the Triple Aim of Healthcare (lower costs, better outcomes, and better experiences for patients and providers) is achievable through proactive, preventive care for individuals and entire populations.
Instead of reimbursing healthcare providers for the volume of services they provide, providers receive payments for meeting quality benchmarks and keeping spending below agreed-upon levels. Providers that succeed in hitting their targets and cutting costs are typically eligible to receive a portion of the shared savings.
In some models, called downside risk models, participants that exceed spending thresholds are also liable to return a part of the overages back to their payer partner. The downside risk is balanced by a greater proportion of the shared savings if they successfully meet their goals.
VBC has proven to be an impactful strategy for Medicare and many commercial payers, saving a gross of $8.5 billion for Medicare alone since 2012. It has also become a popular methodology in the Medicaid environment, and there are growing efforts to shift more and more dollars into pay-for-performance models in many states.
For CHCs, who get approximately half of their reimbursements from Medicaid, VBC represents a promising opportunity to take advantage of the same type of revenue enhancements as their peers in private practice and escape the endless cycle of shoestring budgets and grant applications.
Related: Get our guide outlining the opportunities in value-based care for health centers.
Community health centers, including Federally Qualified Health Centers (FQHCs), have been slower than other provider types to join the VBC movement. That’s partly because many models are not designed to account for the unique features and needs of CHCs.
But it’s also because value-based care sometimes appears to be too risky for CHCs with tight financial constraints. The idea of potentially losing even a small amount of revenue in downside risk models, even for the chance of greater rewards, has kept many CHCs away from engaging in these contracts.
However, a growing number of CHCs aren’t letting apprehension hold them back. They recognize that it’s only a matter of time before VBC makes its mark on the community health space, and they would rather be on the leading edge of the change.
“We’re so used to viewing healthcare and the delivery of healthcare in the lens we’re comfortable with. But if you’re not a lifetime learner and willing to be vulnerable, you’re never going to grow,” says James Powell, MD and former Chief Executive Officer at Long Island Select Healthcare (LISH). “If we could use VBC to move the quality metric needle of our patients, that would be phenomenal, and if there’s an opportunity to obtain profit that could then be applied to staff who are doing the work, then that would be even better.”
LISH is seeing early success with its value-based care journey thanks to its partnership with Yuvo Health. Working together allows LISH to access beneficial VBC contracts with its most important payers while leveraging Yuvo’s hands-on expertise in regulatory issues, clinical quality improvement, and workflow optimization to prepare a long-term future in value-focused community care.
“You have to find the balance in purpose and profit in an organization like ours,” said Powell. “If I can have someone help us do both so I can retain my employees and achieve better outcomes for our patients, then that is a win-win.”
Hear from the CHCs who gained the Yuvo Health advantage
Over the past year, Yuvo Health has ramped up its abilities to level the playing field for CHCs by de-risking the equation of value-based care. With Yuvo Health, CHCs have the opportunity to enroll in an independent practice association (IPA) designed exclusively for health centers. The IPA empowers CHCs with strength in numbers to negotiate favorable contracts with payers and combine patient panels for greater success with quality and spending benchmarks.
“By joining the Yuvo IPA, we’re now in an entity with ten times as many patients as we have in our own organization, which really increases our clout when we’re at the table with managed care plans,” explained Mary Ellen Diver, Chief Executive Officer at Advantage Care Health Center on Long Island, NY. “In New York, joining an IPA is the only way for a CHC to get access to higher level downside risk contracts in Medicaid, which we wanted to explore.
“We know that this is where Medicaid is going. Value-based care is the future of healthcare, and we want to be leading the way instead of following behind”
Mary Ellen Diver, CEO Advantage Care Health Center
“We know that this is where Medicaid is going. Value-based care is the future of healthcare, and we want to be leading the way instead of following behind,” she added. “We were fortunate to get connected with Yuvo Health early on based on recommendations from peers, and we’ve been growing and learning together ever since. We feel very ready to take our next steps into downside risk as part of the Yuvo Health community.”
CHCs that partner with Yuvo Health also gain access to hands-on support with improving practice operations, coding and documentation optimization, and clinical quality improvement.
Yuvo Health offers each CHC access to a Program Success Team embedded in the organization to identify opportunities for improvement and provide boots-on-the-ground coaching and guidance to help every CHC meet its quality and financial goals.
“We are very fortunate to be working with Yuvo because now we have so much expertise and passion available at our fingertips to help us along the way,” said Diver.
The Yuvo Health Advantage: How our population health team helps CHCs
Empowering health centers with tools and data to drive quality improvements and reduce MER.
Team-based care enhancing capabilities of all FQHC employees to close care gaps
Enable local FQHC performance manager and team with data and training
Enhance patient engagement and care navigation through digital or manual outreach, tailored by population segment
EHR embedded tools for decision support at the point of care
Analysis and presentation of highest value activities
Individualized, longitudinal, iterative provider engagement and education program
Build practice capacity in leadership and frontline staff through coached projects
Dashboards to focus on quality, risk, utilization, and SDoH action steps
Operationalize consistent use of technology through tools and training
The Yuvo Health Advantage: How our technology team helps CHCs
Smart technological solutions can supply interoperable, accessible and up-to-date patient data, bridging the gap between providing value-based care and getting paid for it.
Yuvo Health is dedicated to working with CHCs on their unique challenges and opportunities, not imposing a “right” or “wrong” way to deliver care.
“We have an excellent opportunity to work together around best practices,” said Rita Bilello, DDS, Chief Executive Officer at Metro Community Health Centers in New York City. “How can we help each other move forward, both from the clinical and the operations side? It gets lonely doing this, and to be able to come together when we know we’re all having the same challenges and say, ‘how are we doing this?’ is rare.”
“Success comes from transparency in the process, as well as the communication and the willingness to work and engage. The financial potential is a huge win, but it’s not the only measure of success. As CHCs, we want a voice. And we want to prove what we’re capable of doing. Yuvo Health lets us do both of those things, which we consider very important to us.”
Case Study: Joseph P. Addabbo’s Quality Metrics Improvements
For more than 35 years, Joseph P. Addabbo (JPA) Family Health Center has been providing care to residents of New York City’s outer boroughs. The majority of JPA’s 37,000 patients are on Medicaid, and come to the health center for adult and pediatric primary care, women’s health services, dental care, behavioral health, and other specialty services.
JPA is no stranger to working in a coordinated, team-based manner to deliver comprehensive preventive care that reaches far beyond an individual’s physical needs. The health center practices “whole person” medicine, augmenting its clinical services with social workers who can provide referrals to transportation, home care, domestic safety resources, and additional socioeconomically focused services.
“The more services we have available, the better. We’re following a model that ensures we’re taking care of the entire patient, not just their medical needs. This allows us to explore all areas of a patient and be a center where all of those issues can be addressed in some capacity.”
Ari Benjamin, MD and Chief Medical Officer Joseph P. Addabbo
JPA’s experience meeting clinical, behavioral, and social needs as part of its commitment to holistic care made it a perfect candidate to adopt its first value-based care contracts.
Under traditional fee-for-service reimbursement structures, the health center couldn’t bill for all the time and effort required to resolve issues related to the social determinants of health (SDOH), despite the widespread recognition that these activities contribute to better clinical outcomes and lower overall costs for the health system.
It would take a paradigm shift to start aligning what’s best for patients with what is financially possible for CHCs to achieve. That’s where JPA’s collaboration with Yuvo Health began.
In March 2022, the two organizations began to work together to establish contracts with JPA’s major managed care partners.
“Our partnership with Yuvo couldn’t come at a better time to help us pivot and to continue to try to maximize reimbursements, because the states are still not being great to community health centers in terms of payments,” said Miriam Y. Vega, PhD, Chief Executive Officer at JPA.
“A good partnership makes us able to provide the quality care that we believe in so strongly.”
Miriam Y. Vega, PhD and CEO Joseph P. Addabbo
Over the past year and a half, the collaboration has brought Yuvo Health’s Program Success Team together with JPA’s clinical and administrative leaders to take a close look at existing operations and find places to trim inefficiencies, enhance documentation, and ensure JPA could meet its obligations to both its patients and payers.
Rethinking risk capture with focused education
Risk capture can be a tricky area for CHCs. Providers and payers are both wary of over- or under-coding – but at the same time, it’s critical to accurately and completely understand a patient panel’s existing health burdens to correctly set benchmarks for quality and financial improvement.
Many CHCs under-code their patients, either out of an abundance of caution or because their clinicians do not fully understand how to code appropriately, explained Ari Benjamin, MD and Chief Medical Officer at JPA.
“These are things that are not necessarily taught to providers in medical school,” he said. “Members of the Yuvo team have scheduled both group sessions and one-on-one sessions with our providers to help them with their coding and documentation, which is very important to prepare for the transition to value-based care. It would be a lot more difficult to make that leap without that kind of focused help from someone who understands what health plans are looking for.
Yuvo Health helped JPA identify providers with the greatest opportunity for improvement, including those with the largest patient panel size, lowest risk scores, and the least specificity in certain key coding areas. These providers with Yuvo experts both in person and virtually in short, 10-minute bursts that included personalized feedback on their coding and quick tips for making their documentation more complete.
The education started paying off almost immediately. By correctly capturing clinical complexity, JPA saw an appropriate increase of its risk scores among providers who worked with the coding experts, enabling the CHC to have more accurate discussions with its payers about benchmarking and reimbursement.
“Education is so critical, but it has to be done right,” said Vega. “We love that our providers get to go to ‘Yuvo University’ for help. Now, they feel an enhanced sense of efficiency in their own work and feel that they're making progress. The importance of that sense of empowerment can’t be overstated.”
“Members of the Yuvo team have scheduled both group sessions and one-on-one sessions with our providers to help them with their coding and documentation, which is very important to prepare for the transition to value-based care.”
Ari Benjamin, MD and Chief Medical Officer Joseph P. Addabbo
For example: A beloved, long-serving physician at JPA knows his patients so well that he didn’t see the need to write detailed notes about them. But his minimal notes weren’t adequate for the CHC’s value-based care needs – nor would they help other providers understand his patients’ care once he retires. Yuvo Health worked closely with the physician, as well as his nurse and medical assistant, to explain the rationale behind more detailed coding and share strategies for ensuring that documentation was always complete and correct. Now, health plans have a clearer idea of what these patients need and are more willing to approve necessary services quickly. The result is improved care for patients, better communication between providers, and enhanced revenue opportunities for JPA.
Exceeding quality targets with a framework for continuous improvement
Clinical quality is central to JPA’s mission, so it was important to harness Yuvo Health’s expertise in breaking down key quality measures and optimizing performance in those high-value areas.
“Getting a better grip on our data has allowed us to improve our metrics significantly,” said Benjamin. “Now, we can readily share care gap lists with our providers and use pre-visit planning strategies to make sure clinicians know, before their patients come in, what items they may be missing so they can address those issues during the visit instead of trying to catch up afterward.”
“Since the beginning of our partnership with Yuvo, we have been fortunate enough to see improvements in almost all our quality metrics.”
Miriam Y. Vega, PhD and CEO Joseph P. Addabbo
These activities are part of a coordinated, long-term effort to establish a culture of coordinated, proactive, and data-driven quality improvement. JPA is also working to establish new workflows around chart reviews, data transparency, and cross-provider communication to make certain that care teams are equipped with timely and accurate information about gaps in care.
“Yuvo’s team worked both with our front desk and with our clinical staff, identified key people on each team at each site, gave them very defined roles, helped them with the tools that they would need to get those care gaps,” said Benjamin. “I'm very excited to have them help our staff and our team not only understand the details of it but also the reasons why we're making these important changes to how we see our patients every day.”
The efforts are bearing fruit with significant improvements in quality measure performance across several areas.
Increased from 49% to 57%, placing JPA in the 90th percentile for performance.
Child and adolescent well visits
More than doubled from approximately 26% to 54%.
Breast cancer screenings
Up from 57% to 61% for eligible patients.
JPA’s increasing performance doesn’t just benefit the patients that walk through its doors. As part of the Yuvo Health IPA, the CHC’s exceptional results also drive up performance statistics for the entire collective, allowing all members of the community to gain an edge in shared performance contracts.
Over time, JPA expects its quality performance to continue to improve as staff become more familiar with the tools and techniques around delivering preventive care and avoiding gaps in services.
“The partnership with Yuvo has been fantastic,” said Vega. “Yuvo has essentially become an extended arm of our provider department. Overall, the experience has been very positive. They're very supportive. They are very easy to get in touch with. They are very knowledgeable. They are very good at assisting without being critical, and they are helping us prepare for a future where value-based care is the dominant model for reimbursement.”
This video with Dr. Vega and Dr. Benjamin of JPA walks through the efforts they took to improve their quality metrics with more specificity.
Value-based care can certainly be challenging for CHCs, but it doesn’t have to be overwhelming or financially risky. With the right strategies and the right partners to provide help along the way, CHCs can take advantage of everything VBC has to offer to their organizations and their patients.
The past year has proven that CHCs are more crucial than ever to the communities they serve. It’s key that health centers find sources of strength and support to keep thriving in the face of adversity.
“There are people on our side willing to take a risk on us,” said Bilello from Metro Community Health Center. “Yuvo Health is willing to work with us around the challenges that CHCs have in the value-based conversation. We need someone like Yuvo to come in, eliminate the barriers, work with us, assist us with finding the creative workarounds to obstacles that are in our way. I’m excited for the growth opportunities for our organization and for the future of value-based care for all CHCs.”
After a phenomenal year of growth, learning, and partnership with the CHC community, Yuvo Health will continue to expand its IPA throughout 2024 and beyond to give community health centers the best possible chance to improve care quality, maximize revenue, and forge a new path forward into the era of value-driven community care.