Taking risks and embracing technology to improve community health
Community health centers are well positioned to participate in value-based care (VBC) models, but how many are prepared to meet the requirements of a VBC contract?
The work you’re doing day in and day out is, no doubt, lowering costs for payers and improving health outcomes for patients, but do you have data to prove this? Are you screening for social drivers of health (SDOH)? Do you track community referrals to better understand your patients’ progress?
Implementing data-driven technology into your daily operations is no easy feat. You have to invest time and effort into training your staff and changing your systems and processes to ensure that these solutions are successfully adopted. This additional work is cumbersome. It requires participation from every member of the team. It’s a large investment for community health centers (CHCs). And, at the same time, it’s a sure-fire way to improve operations, community outreach and patient outcomes.
This month, we’re tackling the data dilemmas facing community health centers and outlining the benefits of downside risk. Read on for more.
Enjoy,?
Cesar Herrera?
Co-founder and CEO
Yuvo Health
In today’s email:
Technology-enabled products can help CHCs access the benefits of value-based care arrangements
Value-based care (VBC) arrangements can offer FQHCs an opportunity to get paid for work they’re already doing well. But FQHCs’ ability to enter into these arrangements is often difficult.?
However, as our latest guide shares , the right technology-enabled products can help make the job easier. Specifically, product integrations that help aggregate, normalize and share relevant patient data with providers right at the point of care can help FQHCs manage risk, Quality metrics and more.
Take the example of a clinic with a large patient population experiencing diabetes. When equipped with the additional information that the majority of these patients are living in a food desert, an FQHC can think about creative ways to address both clinical and social needs – perhaps by creating a low-cost food mart on the premises so that healthy food options are more accessible. This, in turn, can help improve the health of these patients by supporting gap closure and mitigating risk?
But while data drives decisions like the one above, it’s only useful if it’s easily accessible. That’s where the right products come into play. With streamlined solutions that can alleviate the burden of data management off of clinical staff, excelling on the metrics that support entry into value-based care arrangements becomes much easier. Using the right products can help by:
Walk-in patients account for a significant portion of the average FQHC’s case load. Therefore, providers often have minimal time to track down and review a patient’s medical record before seeing them in a clinic.?
For FQHCs, providing medical care without considering the social factors that impact the health of the populations they serve is akin to washing your hands and drying them in the dirt. However, accessing streamlined SDOH data isn’t as easy as it sounds.
The amount of healthcare data generated every day is enough to overwhelm even the most tech-savvy employee. But the information FQHCs get from Health Information Networks (HINs) and Health Information Exchanges (HIEs) is vital for clinicians to have in order to provide comprehensive patient care.?
Download our latest eBook, Data dilemmas: Why value-based care can remain out of reach for FQHCs without help from innovative technological partners to learn more about the specific ways technology-enabled products can help support FQHCs on their journey to participating in value-based care contracts.
3 questions on downside risk and what it means for FQHCs
What are the risk pathways in value-based care?
Value-based care is the idea that healthcare providers should be reimbursed based on the value they provide to patients, not the volume of services they deliver. In a VBC model, contracts include upside risk, downside risk or a combination.?
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In upside risk arrangements, participants who keep their spending below specific thresholds while meeting their quality targets can keep a portion of the difference between the projected spend on a given population and the actual spend. In downside risk, participants still get to keep a portion of the shared savings if they meet their clinical and financial targets.
Is downside risk worth it?
The greater the risk, the greater the reward. In downside risk, participants usually get to keep a larger percentage of the shared savings than they do in upside-only risk contracts. The extra incentive is necessary because of what happens if a participant goes over budget. If a provider exceeds spending thresholds, they need to return a percentage of the overages, or shared losses, back to the payer.?
Shifting to team- and non-visit-based care leads to a better financial outcome , as the proportion of patients reimbursed under capitation increases. After the shift to team- and non-visit based care, the annual net surplus per physician increased from $35,890 under traditional fee-for-service to $120,654 at 50% capitation and $205,418 at 100% capitation.?
How can FQHCs benefit from downside risk arrangements?
Within the value-based care model, participants are reimbursed based on the value they provide to patients, not the volume of services they deliver. This financial arrangement is designed to reward FQHCs for what they already do well. Taking on more risk requires health centers to build operational competencies so they are best equipped to provide preventative care, implement care coordination measures and address population health. When FQHCs increase quality of care, they lower costs – this benefits the patient, the payer and in a downside risk model, the participating health center.
“Value-based care holds much promise by creating supportive collaborations between patient and physician, improving quality of care, and reducing healthcare spending.”?
- Dr. Steven Waldren, MD, MS, Chief Medical Informatics Officer at AAFP for HIT Consultant
Industry links
What’s changed since COVID-19? Total Medicaid spending growth slowed, dropping 1.5% from 2022 to 2023 and the unwinding of Medicaid continuous coverage is expected to have a significant impact on enrollment and spending in 2024.
President of Milbank Memorial Fund Christopher Koller addresses an ongoing concern: a rapid decline in primary care, which has a direct impact on patient care, population health, and health equity. His recommended solutions? Focus on five key areas: payment, access, workforce, information technology and accountability.?
Here’s a helpful guide for understanding value-based care and all the lingo that’s associated with it. Shared savings, risk stratification, HEDIS “Quality” and other terms are defined here, so save this and return to it when needed.?
CMS has implemented new social drivers of health (SDOH) policies, including separate payments for services addressing social barriers, which will support better care coordination and improve patient access to care, such as the ability to access patient navigation services.
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Get the guide on data dilemmas for FQHCs
In case you missed it…
We know you know, but the Commonwealth Fund highlights the important work that FQHCs are doing and why this needs to be rewarded and dives into a few key policies that are helping improve financial outcomes for health centers.