Why should you care about the new New York section 1115 amendment?

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You may have heard, but big things are happening in New York. A new amendment to a section 1115 demonstration was approved by CMS, which could help advance health equity among Medicaid members, including those served by FQHCs.?

While this news is state specific, it could (arguably, should) influence other states to follow suit. According to CMS Administrator Chiquita Brooks-LaSure , “The demonstration’s initiatives will provide a broad swath of health and social supports to underserved communities, improving their health and quality of life. We encourage other states to follow New York’s efforts to address health disparities.”

In this issue, we’re exploring the new amendment – what it is, what initiatives are included, and why it matters for the future of value-based care. Even if you’re not in New York, you’ll want to stick around and learn more about this groundbreaking effort to bridge health equity gaps in Medicaid.?

Take care,

Cesar Herrera

Co-founder and CEO of Yuvo Health

The new section 1115 amendment promotes health equity – what FQHCs need to know

In an effort to advance health equity, reduce disparities, and enhance the delivery of health-related social needs (HRSN) services, CMS has approved a new trailblazing amendment to New York’s section 1115 demonstration.?

This waiver includes an allocation of $6.7 billion to help advance value-based payment (VBP) strategies, multi-payor alignment, and population health efforts.?

New programs and initiatives will help drive the state (and our country) toward a more patient-centered healthcare system. FQHCs, along with other stakeholders, will need to work together to drive these efforts forward.

Here’s what will be funded by the section 1115 demonstration waiver:

• A statewide health equity regional organization (HERO), which will focus on telehealth infrastructure, stakeholder engagement, and value-based payment arrangements. This will require FQHCs, among other stakeholders, to build a cohesive, data-focused coalition.?

• HRSN (Health-Related Social Needs) Initiative, which will help improve the relationships between primary care providers and community-based organizations, support social care networks (SCNs), and create new benefits for Medicaid members with complex needs.

• Strengthen the Workforce, which will support existing healthcare professionals and recruit others with Student Loan Repayment and Career Pathways Training (CPT), among other efforts. Ideally, this will reduce the shortages and pave a new path forward for future healthcare workers.

• State Directed Payment (SDP) Authority, granting the state the authority to directly allocate funding to state-specific programs, healthcare initiatives, and other innovative programs. New York has already expressed interest in putting this funding toward Patient-Centered Medical Home (PCMH) programs.

• Provider Rate Increase, with a primary focus on primary care, behavioral health, and obstetrics care. This initiative requires a two-percent point payment increase for Medicaid managed care and fee-for-service delivery systems.

• Continuous Eligibility for Children, providing continuous Medicaid coverage for all children under the age of six.?

FQHCs should feel encouraged by this new amendment, as it opens new pathways for engaging in conversations and advancing efforts around healthcare delivery, social services, and integrative programming. The funding will make it easier for New York FQHCs to build technology-enabled systems, join value-based payment arrangements, and secure funding for health-related social needs (HRSN) services.

This isn’t the first state to receive funding for HRSN-related services. Arkansas, Arizona, California, Massachusetts, New Jersey, Oregon, and Washington have approved similar initiatives. But this is a monumental effort by CMS to change the way we, as a society, approach health care delivery. Moving toward a patient-centered system, siloed stakeholders will have to initiate conversations and build systems and protocols for sharing data and making data-informed decisions around population health.?

To learn the status of section 1115 waivers in your state, check out the Medicaid Waiver Tracker here .

3 questions with Sarah Hoehnen, DO, Chief Medical Officer at My Community Health Center (MCHC)

Located in Canton, Ohio, My Community Health Center (MCHC) provides a wide range of telehealth and in-person medical and social / care management services to residents, including primary care, well child services, obstetrical care, and social services assistance. In 2022 alone, the center —?a Yuvo Health partner —?served more than 10,000 patients and just recently they opened an in-house pharmacy, as well as a third location.?

We spoke with Sarah Hoehnen , DO, Chief Medical Officer about the work that MCHC does.?

Why is it so important for FQHCs – and primary care providers, in general – to take a preventative approach to care?

We’ve seen real divides in inequitable access to care and delivery of services. We need to level the playing field so everybody gets the same access to care and services, regardless of who they are, what clinic they go to, where they live, or what they look like.?

Heading into 2024, what are your greatest concerns for community health and how do you plan to tackle them?

We are shifting the paradigm of primary care. The bedrock of good care for anyone is based on trust. If we don’t have trust between the provider and patient, healthcare becomes a drive-thru, fast food type situation. You lose continuity and you lose the opportunity to focus on prevention and address actual needs. We need to integrate behavioral health into the medical setting, focus on a whole-person approach, recognize the disparities that exist for those getting care, and create social safety nets.?

How does technology support your clinical work at MCHC?

Technology makes life easier, but also more challenging. It has the potential to be beneficial for both the provider and the patient, but only when clinical care works with it and not against it. As a clinician, if I’m working ten hours, I shouldn’t be spending four of those hours on medical records. With technology, there are more requirements for documentation and while data is good, someone has to spend time entering and analyzing it. We need to ensure that clinicians are focused on providing care – and find other ways to automate data collection.?

At the same time, telehealth has helped address transportation barriers and social anxiety and technology has offered us new ways of engaging with patients, such as through text messaging. What I’m learning is that to fix big problems, you have to have big solutions. This takes time, as well as stakeholder buy-in and training. We can’t use band-aid solutions anymore.

“When I think about the care that’s being provided, I think, ‘what type of care would I want my mother, daughter, or myself to get?’ I don’t want my provider to be confined. I want them to have access to all of the best tools for addressing their patients’ needs.”

Ami Patel , MD, Chief Population Health Officer at Yuvo Health

Industry links

America Needs Community Health Centers, But These Health Centers Need Funding

Dave A. Chokshi, MD contributed this opinion piece on The Hill about why robust funding for community health centers matters for us all. Dr. Chokshi is a physician at Bellevue Hospital, Sternberg Family Professor of Leadership at the City College of New York, and the former New York City Health Commissioner. He also serves as an independent board member of Yuvo Health.

HHS Roadmap for Behavioral Health Integration Fact Sheet of Accomplishments

Some key highlights from the U.S. Department of Health and Human Services (HHS) : new efforts are being made to support and increase the workforce of behavioral health workers, value-based pay arrangements and innovative technologies are using data to drive more effective care coordination and delivery for patients, and more support systems are being developed to care for high-risk populations, such as pregnant people, victims of domestic violence, and children in the welfare system.?

The Two Health Care Cost Crises

Medical debt and national health spending are proving to be costly problems. Some solutions, including transparency initiatives and reducing monthly copays for prescription drugs like Insulin, are considered in this piece from KFF .

Bringing Value-Based Care to Rural and Underserved Communities

The National Association of ACOs offers new ways to support medically underserved communities. Some of them include creating new payment arrangements for safety-net providers, waiving one-visit, one-service requirements for FQHCs, and removing face-to-face billing requirements for annual wellness visits.?

Access to Federally Qualified Health Centers and HIV Outcomes in the U.S. South

A recent study published in the American Journal of Preventive Medicine shows (not surprisingly) that FQHCs help improve HIV prevention, care and treatment for at-risk populations.?

HHS Announces Top Health Centers for Clinical Quality Excellence

Gold Health Center Quality Leader badges are given to health centers based on outstanding performance in a variety of clinical areas, including behavioral health, maternal health, diabetes health, heart health, cancer screening and HIV prevention and care, as well as overall quality performance. Learn which centers were awarded in 2023 over on Health Resources and Services Administration (HRSAgov), HHS .?

Get the eBook on data dilemmas for FQHCs

In case you missed it...

Medicaid and CHIP Renewals: Patient-Centered Messaging for Clinical Offices and Health Care Settings

Don’t forget to check out this resource, which includes messaging for e-newsletters, recorded phone messages, outreach materials, and more. Use these as is – or take the templates and personalize for your own center. ?

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