Advantage Care Health Centers on Long Island, NY, has two care sites that offer a wide array of primary care, dental, and mental/behavioral healthcare services to thousands of underserved residents. With a strong background in supporting people with intellectual and developmental disabilities (IDD), Advantage Care knows all about how to identify potential and bring out the best in every situation.
That’s why the Federally Qualified Health Center (FQHC) has invested heavily in transformational technologies and payment models that foster more coordinated, financially sustainable operations, says CEO Mary Ellen Diver.
“FQHCs sometimes feel like we’re one step behind other types of care providers in terms of how we can innovate, but that’s not the case,” she said. “There are so many opportunities to engage with the evolution of the healthcare systems, whether that’s through grants and recognition programs or partnerships with payers and value-based care experts.”
Advantage Care has a series of successful developmental grant programs under its belt, including projects to expand telehealth, launch an Open Notes initiative, and expand the presence of community health workers. Now, the health center is ready to lean into value-based care contracts, particularly in the Medicaid managed care space.
“We are a little unique in that about 99 percent of our patients have Medicaid as one of their insurance options,” explained Darci Weissbrot, Director of Operations/Compliance. “About sixty percent are dual eligible for Medicare and Medicaid, as well. The fact that we have very few uninsured individuals puts us in a good position to benefit from value-based care contracts with the managed care plans in New York State.”
“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. 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.”
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An introduction to value-based care in a changing environment
Medicaid in New York State is transitioning away from its 5-year DSRIP program and rolling out a new Value-Based Payment Roadmap to continue its journey away from fee-for-service healthcare.
The new approach borrows many of DSRIP’s successful elements, including the use of quality measures to hold contracting entities accountable for outcomes and costs, as well as the use of varying upside and downside risk pathways to meet the needs of different organizations.
“As an FQHC, the only way to participate in the Level 2 or 3 pathways, which include downside risk, is via an independent provider association (IPA) or similar entity,” said Weissbrot.
“We already had an upside risk contract with one of our managed care plans as part of our Patient-Centered Medical Home (PCMH) recognition, but were looking to join a network that would give us access to those downside opportunities while allowing us to remain fully clinically independent.”
“Fortunately, we were introduced to Yuvo’s CEO, Cesar Herrara, through our friends at Long Island Select Healthcare (LISH), and everything started falling into place.”
Working toward downside risk opportunities as a team
Advantage Care signed up with Yuvo Health when the latter was still a relatively new entity. Far from that being a deterrent, however, Advantage Care embraced the chance to get in on the ground floor of an exciting new approach to value for FQHCs.
“We knew from the start that we were aligned with Yuvo’s mission,” said Diver. “We believe they understand the unique needs of the population we serve, including our IDD patients, and we’re thrilled about how we’ve been able to innovate together and bounce ideas off each other as we continue to explore how value-based care is going to work for FQHCs.”
As Advantage Care works toward establishing downside risk partnerships with its major managed care plans, Yuvo Health offers the additional benefit of bringing bigger patient panels and more potent negotiating power to the table, added Weissbrot.
“We are a relatively small FQHC with about 2,500 patients across our two care sites,” she said. “By joining the Yuvo IPA, we’re now in an entity with ten times that many patients, which really increases our clout when we’re at the table with managed care plans.”
“And because we serve something of a niche population with our IDD folks, we need to work with other FQHCs to have enough of the right mix of patients meet some of the quality measures that we typically don’t have the chance to address in our patient panel, such as maternity-related metrics. As a team, however, we now represent a much wider and more varied population – that gives everyone a better chance of filling in gaps that they might not be able to meet on their own based on the patients they serve.”
Charting a course for the future with value-based contracting
Diver and Weissbrot acknowledge that the idea of value-based care doesn’t always instantly appeal to members of the FQHC community, especially those that are cautious about making any changes to their already-precarious financial situations.
But the opportunities are starting to outweigh the risks, they pointed out, especially as states accelerate the integration of value-based principles in their Medicaid programs.
“Value-based care is coming, but that doesn’t have to be a scary thing,” said Diver. “You just need to find the right partners and invest in the right practice transformation efforts to get prepared for the care coordination and population health management activities required. We are very fortunate to be working with Yuvo because we have so much expertise and passion available at our fingertips to help us along the way.”
“We don’t need to reinvent the wheel, and we don’t need to do this in isolation. That’s incredibly comforting and empowering. Healthcare is moving toward a very bright future, and we are ready to be a leader in this new era of care.”