Hands-on support for value-based care: how a New York FQHC leverages technology to achieve results for clinicians and patients

In partnership with Yuvo Health, Joseph P. Addabbo Family Health Center has taken huge steps toward success in value-based care by implementing new technologies that assist with closing care gaps, creating accurate risk scores, and streamlining coding and billing.

Introduction

For community health centers (CHCs) serving diverse, high-needs populations, value-based care (VBC) can offer a pathway to better experiences and enhanced financial sustainability. With well-defined quality and spending targets and a variety of financial incentives to reward successes, VBC contracts can enable FQHCs to capitalize on their proven ability to deliver exceptional care with an eye toward appropriate use of resources.

The FQHCs that choose to pursue this path understand it can be challenging – but those that are partnering with Yuvo Health and leading the way toward more value-driven community care also understand that they have an experienced partner and tailored digital tools to make the journey easier and more productive.

At Joseph P. Addabbo Family Health Center in New York City, for example, organizational leaders have been working closely alongside Yuvo Health to implement a series of strategies and digital capabilities that are helping them to meet their VBC performance goals. The hands-on support and intuitive technology from Yuvo Health have already helped Addabbo achieve shared savings, increase care gap closure by 20%, and created what Ari Benjamin, MD, Chief Medical Officer at Addabbo calls “a transformative step for our organization.” Here’s how they did it.

The challenge

Coordinated, proactive and comprehensive care delivery is essential in the value-based care environment. Yet providers at Addabbo didn’t always have access to all the necessary diagnostic and treatment information about their patients, especially after an emergency department visit, hospitalization, or other external care event.

Not only did this make it difficult for providers to close gaps in care, but it also presented challenges for developing accurate and complete risk scores for their contracted populations.  As a result, Addabbo may have been missing out on opportunities to be appropriately compensated for the care they were delivering for patients who may have actually been sicker than their documentation indicated.

Addabbo needed to take a more data-driven approach to getting access to key health data from across the region. They needed new techniques for leveraging this information to streamline accurate coding and risk scoring without increasing administrative burdens. And they needed better tools for presenting data about care gaps and rising risks to providers in the clinic, where it could make the most difference for patients. Yuvo Health has been instrumental in providing the right solutions for these challenges.

The solution

As part of the partnership with Yuvo Health, Addabbo now has access to a suite of technology tools curated specifically for the FQHC environment. Strong commitment from the executive team, as well as hands-on support from Yuvo’s coding and technology experts, is helping maximize the impact of bringing enhanced health information exchange, analytics and risk scoring capabilities into the organization.

Related: “Empowering FQHCs with the technology tools to meet their value-based care goals”

“It can be a challenge to have the resources to keep up with care gaps and diagnosis gaps. Technology can be a solution, but only if it is introduced in a way that generates buy-in among its users,” said Ari Benjamin, MD, Chief Medical Officer at Joseph P. Addabbo Family Health Center. 

“When we first started working with the Yuvo team, they understood that we needed a straightforward, effective solution with a minimum number of clicks.

‍- Ari Benjamin, MD, Chief Medical Officer, Joseph P. Addabbo Family Health Center

Dr. Benjamin continues, "They provided an integrated and intuitive technology suite alongside a huge amount of education through their coding team, which works with providers on a one-on-one basis to make them more aware of the benefits of the platform and how to best use the tools.”

The Yuvo Health team is physically on site at Addabbo’s clinics several times a week to assist with questions or provide training, and providers have access to technical assistance through a dedicated email address monitored by a senior staff member, with the vast majority of queries resolved within 24 hours.

“We know one-and-done training doesn’t work. People won’t attend; they will forget what they learned; or they won’t be convinced that they have to care," says Yuvo Health Director of Product Implementation and Support Sachin Malik.

"We bring continual reinforcement and customized training into the FQHC as often as necessary to reduce barriers and boost engagement. We’re serious about what we’re doing here, and about making technology work for your organization. We’re going to do whatever it takes to help you achieve results.”‍

- Sachin Malik, Director of Product Implementation and Support, Yuvo Health

This wrap-around support has made it possible for Addabbo to adopt Yuvo Health’s “tech flywheel,” a series of integrated technologies that aggregate, curate, and present high-value data at critical junctures in the care process. 

For example, Addabbo now has access to the VIM Population Health Platform: a widget that sits within the EMR workflow to highlight high-priority care gaps and support more accurate coding and treatment. Providers and team members can now view claims data, patient health history, admissions, discharges and transfer (ADT) data and more from multiple sources directly within the EMR.

“The platform allows you to proactively address care gaps that might occur when patients move through different care settings,” explained Dr. Benjamin.  “I remember that one of my patients was diagnosed with acute kidney failure during a recent hospitalization. I saw the new diagnosis on the VIM platform and was able to work with them during that visit and follow up appropriately to better manage the condition over time.”

Related: “FQHCs receive true partnership and make lasting impact with Yuvo Health”

The results

Addabbo is one of several FQHCs that achieved shared savings in the first year of Yuvo Health’s value-based contracting program with Fidelis Care, a statewide health plan with more than 2.4 million members in New York State and a wholly owned subsidiary of Centene Corporation. Addabbo’s strong commitment to continuous improvement and data-driven care strategies was instrumental in successfully implementing risk adjustment and quality initiatives that resulted in a net savings to the network, as well as improvements in key quality metrics. 

With VIM and other components of the Yuvo Health tech flywheel, Addabbo is taking even more steps into success with measurable improvements in efficiency and quality. Now, more effective and efficient patient visits have led to a 33% increase in care gaps addressed at the patient visit and a 20% increase in care gap closure.

Leaders at Addabbo attribute these gains to Yuvo’s at-the-elbow approach to providing customized training and education. Thanks to reliable access to support, as well as financial incentives for promoting user engagement, VIM utilization is up by approximately 27% across the organization.

“This has been a transformative step for our organization,” said Dr. Benjamin. “The platform’s robust data capabilities have empowered our providers to make more informed clinical decisions, ultimately enhancing the quality of care we deliver to our patients. We are excited about the potential of this tool to continue improving health outcomes for our community.”

Addabbo and Yuvo Health are currently rolling out additional capabilities, including quality measurement functionalities, that will continue to inform the patient-provider relationship. 

For Dr. Benjamin, the mutual trust, respect, and open communication between Addabbo and Yuvo Health are the anchors for a relationship that is producing significant benefits for the organization and for the community it serves.

“We are very fortunate to have Yuvo as a partner for our value-based care journey,” he said. “They have deep experience with FQHCs, but they know how to listen, how to take in feedback on what makes each organization unique, and how to apply those learnings in a way that elevates the culture of care in every health center."

"We are seeing the results of our work very clearly so far, and we’re eager to continue achieving our objectives alongside Yuvo in the future.” 

- Ari Benjamin, MD, Chief Medical Officer, Joseph P. Addabbo Family Health Center

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