Innovating to Address Social Needs in the Community
Hi, welcome to July's edition of The Community Health Corner.
Before meeting the leadership team at Public Health Solutions (PHS), I was fascinated by the organization’s history. What was first established as the Medical and Health Research Association of New York City (MHRA), a research organization focused on disease prevention among underserved populations, has since become the largest public health nonprofit serving New York City.?
On a mission to give every New Yorker a fair and just opportunity to be healthy, PHS provides direct services to the community, gives administrative grant support to community-based organizations, and develops accountable networks that help coordinate service delivery across the city. Every day, PHS is tackling numerous public health issues, from food and nutrition to reproductive health and HIV/AIDs prevention. Since building their own social determinants of health (SDoH) network WholeYouNYC, they’ve looked for more ways to meaningfully engage with primary care providers – and that’s where Yuvo Health came in.
When I first met the folks at PHS, I immediately felt a kinship. All of them are mission driven. They know firsthand the value of health equity and are focused on improving health outcomes in vulnerable communities. It’s one of the many reasons why we chose to partner with them. In today’s newsletter, we give you a glimpse into the incredible work that PHS is doing to support FQHCs and the community.
Best,
Cesar Herrera?
In today’s email:
Addressing Social Needs Through Value-Based Care Models: How FQHCS Can Innovate?
The healthcare system is actively shifting away from fee-for-service models and moving toward value-based care. This puts greater focus on prevention and wellness and gives providers and payers new opportunities to work together and change the way Medicaid pays for care.
This is a “really interesting time to be innovating,” Andrey Ostrovsky, MD, former chief medical officer of the U.S. Medicaid program, said in the Center for Community Health Solution’s recent webinar . “We have a really robust federal backdrop to enable states like Ohio to advance value-based payment and do it in a way that’s focused on quality measurement, quality improvement, and transparency.”?
Prior to the implementation of the Next Generation (Next Gen) managed care plan in Ohio, there wasn’t a lot of clinical accountability in the state, Dr. Ostrovsky explained, but now the program is focused on securing high-quality, evidence-based health care for Ohioans, which will give FQHCs and other community health centers the opportunity to provide more preventative care and get reimbursed for it.?
In lieu of services (ILOS), for instance, allows Medicaid managed care plans to pay for alternative services without the need for an approved waiver. Covered expenses can include nutritious meals, personal care services, housing navigation, or air purifiers, so long as they are medically appropriate and cost-effective, which enables providers to treat patients’ social needs.
“In order for us to provide whole person care, we have to be able to do things innovatively. You cannot innovate in a fee-for-service model,” Adam Aponte, MD, MSc, FAAP, Chief Medical Officer at East Harlem Council for Human Services. This model isn’t conducive to care managers, home visits, and securing nutritious foods.
FQHCs are required to see new patients within four weeks, but most patients walking through the door are dealing with chronic conditions, said Dr. Aponte. In a value-based model, providers can be more innovative with their care and shift to care management, secure care navigators, and helping patients address food insecurity, home instability, and other concerns that prevent them from achieving health and wellness. It’s all about the “quality of care as opposed to the quantity of care,” he said.?
The challenge for FQHCs, though, is that these value-based models come with upside risk and downside risk, Dr. Aponte said, admitting he’d take on downside risk if he could, as he’s confident in the quality of the organization’s work, its ability to engage patients, and reduce emergency visits.?
“[As a non-profit] we have to make money, but not at the cost of compromising care,” said Dr. Aponte. Thankfully, providing the highest quality care possible, Dr. Aponte has found that East Harlem Council for Human Services has been able to better engage in quality-based incentive programs and this has helped increase margins and better serve the community.
Do you get reimbursed for services addressing social needs??
3 Questions with Zachariah “Zach” Hennessey, Executive Vice President and Chief Strategy Officer at Public Health Solutions
Q1: What’s changed since Public Health Solutions first started and how do you support the community?
We’re at a pivotal moment right now for public health in the United States. For the first time in history, life expectancy is on the decline and health disparities are persistent or widening. And Public Health Solutions exists to change that trajectory. Our mission and vision are focused on health equity.
We help put nutritious food on the table for families. We help them access free or low-cost healthcare, including healthcare provided by Federally Qualified Health Centers (FQHCs). And we help them enroll in benefits. We also make sure there’s adequate access to sexual and reproductive healthcare. We support families through the pregnancy and new parenting process. We work across the lifespan with families to help them address social determinants of health (SDoH) and the impact on their everyday lives.?
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Q2: What is the value of FQHCs, and how does Public Health Solutions work with them?
Federally Qualified Health Centers are really essential to advancing health equity. We are in true solidarity with them. Unfortunately, they are undervalued because of the wrong pocket problem. The economic value of the work being done by FQHCs accrues to the health system and health insurance companies because it’s very preventive. It's very upstream. It really helps keep people from getting very sick and showing up to the emergency department and being hospitalized.?
While we do a lot of work with individuals and families, as a public health institute, we work mostly at the community level with community-based organizations and FQHCs. We help strengthen them so they can be better resources to the community. This means providing funding, administrative support, training, technical assistance, and advocating for policies that support their critical work.?
Q3: What are some specific ways that you’ve supported FQHCs?
A big part of our mission is supporting Federally Qualified Health Centers, and we do that in a lot of different ways. We help them access government funding sources, provide them with free training, and critical supplies like personal protective equipment, contraceptives for the uninsured, cribs and diapers for families.?
During the pandemic, we served food to FQHC patients, delivered PPE [personal protective equipment] to FQHC workers. We acquired some of the very first COVID-19 tests on the market and we pushed those out for free to our FQHC partners so that they could test their workers, and those workers could continue to provide lifesaving care, but also keep people out of the hospital during the surge.
You can learn more about PHS and their mission regarding health equity in this video with Zachariah .
“A significant redevelopment of reimbursing health centers with higher reimbursements was just last year and we’ll see that over time, but what’s happening is the workforce crisis is really eating away at the gains from the increased reimbursement. I call it a perfect storm of circumstances.”?
– Michael Curry, CEO of the Massachusetts League of Community Health Centers in conversation with Wbur Radio Boston
Relevant Links
Far too many Medicaid beneficiaries have already lost coverage and states are being encouraged to protect those who still qualify. How can they do this? Adopt flexibilities, pause cancellations, and take advantage of the government’s new waivers and strategies, such as switching to auto-enrollment.?
In 2023, Medicare has already overpaid Medicare Advantage (MA) plans by six percent – and the USC Schaeffer Center Research believes it could exceed $75 billion. How will this problem be solved? Researchers suggest rate setting, including linking plan rates to average spending by traditional Medicare beneficiaries.?
In MACPAC’S June 2023 Report to Congress on Medicaid and CHIP, the Commission offers four actions, which can help enhance the financial stability of safety-net hospitals and offset uncompensated care costs. Among them: making amendments to Section 1923 of the Social Security Act.?
A new CMS model will begin on July 1, 2024 and run for 10.5 years across eight different states. The three-track model focused on building infrastructure, implementing advanced primary care, and organizing care and partnerships aims to help providers transition to value–based care so they can better address social determinants of health (SDoH). Check and see if this model will launch in your state.
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In case you missed it…
Value-based payment models and payer-provider mergers are erupting across the healthcare industry, according to Ezekiel J. Emanuel, MD, PhD, and this could ultimately eliminate the fee-for-service models and push our systems to more preventative, quality-based care. If you’re not yet engaged in value-based care models, now’s the time to start innovating.