Value-based care for community health centers: Yuvo Health's approach

Yuvo Health Founder and CEO Cesar Herrera was recently featured in “Mosaic Founder Stories” by Mosaic General Partnership.

In this video, Cesar shares the North Star that has guided Yuvo Health since Day One: to empower community health centers (CHCs) to extend their care to the 20 million people in the United States who do not have access.

He describes what makes value-based care different for CHCs, how Yuvo Health is connecting CHCs to the resources they need, and why the mission of Yuvo Health is so personal to him.

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Full transcript:

According to the US government, there are 20 million people that don't have access, that need access to primary care—that don't have access to a community health center. And that's not because community health centers don't want to provide more care. It's because they literally cannot. 

Our vision is to enable community health centers, through this additional revenue from value-based care, to not just survive, but to thrive so that they can increase capacity and access to care to these other 20 million people.

What Yuvo Health does is we operate in the value-based care world, very specifically for community health centers. These are really amazing organizations that serve 30 million people across the United States, specifically those that are under-insured or uninsured, and in many cases have no other access point to primary care. And they're doing all this amazing work to keep these communities healthy. 

Community health centers provide critical access to care for uninsured and under-insured people

The US health care system is amazing if you have money. It's amazing if you have insurance. You can get the best care in the world.

But if you don't have insurance, then you have no options (except for going to the ER) except for a community health center. And what I saw broken there was even though community health centers were doing this amazing work to support all these people that otherwise would not have access, they're not being supported by the US government in a meaningful way. Their revenue model is not financially sustainable.

And the work that they do is really everything that the US health care system actually wants every provider to do, but they're not getting paid in the same way. So that's the part of the system that I want to help fix. 

I have lived experience as an FQHC patient. I grew up for the vast majority of my own childhood off and on healthcare insurance. So as you can imagine, where I grew up, there were very few providers that would accept Medicaid or uninsured patients except for community health centers.

And I owe a lot of my own health and that of my community to the amazing care that I received from community health centers. So it was always my mission to find ways to support them to scale. And the ways that I felt I could do that is leveraging my own healthcare background. 

Incentivizing health through value-based care

One of the main reasons why the healthcare system is the way it is, and broken in the way that it is, is because the incentives are not aligned in the right ways. Providers unfortunately are incentivized to treat people that are sick.

The more sick people, the more money a provider makes. And that's really not what we want to incentivize, right? We want to incentivize providers for keeping people healthy, to ensure that they don't have to go to the ER, to ensure that we catch their breast cancer early so that they don't have to go through ten years of chemotherapy just to relapse, right? 

So value-based care is this policy initiative that was really aimed to help realign those incentives.

And the way that it does that is by enabling providers to take on risk. If they're able to drive savings into the system by keeping that patient healthier and maintaining their primary care, then those providers are able to take part in the savings that they've driven into the system. And that additional revenue not only gives them credit for the work that they're doing to drive that system, but also gives them the necessary resources to be able to serve more people better. 

A different system for community health centers

What's important to recognize is that health centers are very uniquely regulated. They don't operate in the same way as, say, your own private practice doctor that you go see. They don't get paid the same way. They don't have the same teams in place. And they just do different work. 

The problem exists from a regulatory standpoint. I would say there's probably some good intentions as to why community health centers are not allowed to participate in value-based care. And to be clear, value-based care can take many forms. The biggest part of that is what's called taking on downside risk.

And that can feel really scary for any provider, let alone a capacity-constrained, resource-constrained health center. I assume, instead of forcing health centers to take on risk in order to make more money, the US government says, "Well, you're just not allowed to. I'm not going to even give you that option." 

The reason why that's detrimental, though, is that means then they don't have any opportunity to make more money, and they need to make more money so that they can serve more people.

Serving more people requires more revenue 

That's really what the name of this game is. These are not-for-profit, community-based organizations. They're using this money to reinvest in their operations so they can scale them to serve more people. We're not the only ones that have identified this problem. And there are many types of organizations that are trying to address this, most notably community health centers themselves. Many of them are trying to organize collectively to be able to participate in taking on downside risk.

What makes it difficult for them though is at the end of the day, it's really hard to make that transition into ostensibly becoming a health insurance company. There are a lot of capital requirements. There's a lot of technology that you have to build. There's a lot of infrastructure that you have to build. And when you're already capacity-constrained, it makes it really difficult to compete with a large health system that has billions of dollars in reserves that they can actually use to build whatever they need to build to take on risk.

Yuvo Health’s role in value-based care for community health centers

Health centers are not allowed to take on risk, so we're not in a position where we're actually enabling them to take risk. We have to be the ones taking the risk. So we built our model wherein we are acting as the risk-bearing entity absorbing all of that so that we can create all this additional revenue. And that's what we then bring to our health center partners because they're not allowed to take that risk.

So in order for us to scale and support our goal and our vision of community health centers serving more people, then we know we can't do that without first engendering trust from our community health center partners. In order for us to do that, we have to make sure that they understand our intentions in a way that is genuine.

We want to support the existing health centers that have been doing this work tirelessly for the last 45 years.

And if we don't engender their trust, then it's all for naught—this ecosystem that we built—because it's dependent on our health centers leveraging that ecosystem. So that's why we have to think about, and we'll always think about, how health centers can inevitably trust us with a really, really important initiative so that they get more resources and the resources they need to scale.

The mission drives us

In our hiring process as well, it's incredibly important for us to have our mission, our culture front and center, because we want to make sure that our people want to serve this mission. This is not easy work. This is difficult work. This is a difficult, difficult problem to solve. And it's going to be really hard to solve the problem if you're not deeply connected to that mission in some way, shape or form.

We just have to be really honest with ourselves about that, and we certainly have. And what we've also been really honest about is our commitment to making sure that our people look like and represent the patients that our community health center partners serve day in, day out, who happen to be predominantly BIPOC, people of color, women, and those experiencing poverty.

Because one in three individuals in the US that experience poverty is served by community health centers. So we take that into account. When we talk to people about opportunities here at Yuvo, we ask them all the questions about how they are connected to this mission. We're measuring success based on that 20 million people that still need access to care—are we able to get there?

The big, hairy, audacious goal

Are we able to increase our health center partner's ability to serve more people? And obviously that's this big hairy audacious goal that we have.

How we see success is incremental. Are we able to show that year-over-year our health center partners are able to see more patients, are able to thrive, are able to grow a new center, launch a new center in this new community that otherwise didn't have a center?

And that's going to be a constant fight and battle, a constant war that we're going to keep waging to make sure that we're making those incremental changes and improvements in the communities that we serve.

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