More and more opportunities are arising for FQHCs in New York State, which has ambitious goals for health system reform, to participate in value-based care.
For five years, New York's $8 billion DSRIP program provided FQHCs with a taste of what value-based reform can look like. With DSRIP on its way out, FQHCs in New York State are taking a new path towards value-based care.
It's now 2022's new Value-Based Payment (VBP) Roadmap that is opening new doors – and bringing additional complexities. The draft roadmap aims to take a more comprehensive approach to value-based care for Medicaid beneficiaries. It creates a wealth of opportunities for FQHCs to accelerate participation in value-based contracts.
New York State authorities are committed to ensuring that the reform process is transparent and fair without unduly burdening or unfairly penalizing participating providers, assert the authors of the Roadmap. With a planned multi-year, phase-in approach and a commitment to ongoing guidance and technical services, the VBP Roadmap intends to encourage broad participation and actively foster success.
As the dust settles on DSRIP and the next iteration of value-based care comes into play, FQHCs have the chance to make the most of these opportunities to enhance and diversify their revenue streams.
Learn more about the VBP Roadmap in our free guide.
To participate in this emerging ecosystem, FQHCs in New York will need to examine their current capabilities and add tools, strategies, and partners across a variety of areas.
Define shared goals and objectives for the organization
FQHCs must start the value-based contracting process with a clear idea of what they hope to achieve and what resources are available to help them achieve it. Executive leaders and clinical champions should come together to clearly articulate the organization’s appetite for financial risk, using historical financial and clinical data to gauge the potential impact of various value-based care models.
Leaders should have a concrete idea of what they can afford in terms of up-front investments in technology, additional staff, physical space, and community programming. They must also make a strong effort to educate staff on all aspects of value-based care and how it might affect their individual workflows and the organization as a whole.
Adapt to changing clinical and operational needs
Value-based care is more than just a different way of getting paid. It requires providers to undertake a holistic transformation in the way patients experience care. FQHCs are at an advantage in this respect, since they already focus sharply on proactive, preventive, person-centered care. But there will still be changes on the horizon.
Success with value-based care requires enhanced capabilities around risk stratification, accurate and appropriate coding, quality measurement, health information exchange, and patient engagement. While there are technologies available to help with each of these areas, FQHCs may have to prioritize their investments and employ creative strategies to start building momentum for success.
Align with peers and partners to engage in advantageous contracts
Fortunately, FQHCs don’t have to do all of this by themselves. Partnerships will be essential for accessing more advanced opportunities and succeeding with quality and financial goals.
FQHCs should look for partners with previous contracting expertise and deep knowledge of the community health space. These partners should be able to provide detailed insight into how to design contracts that are most advantageous for the FQHC – and be unafraid to firmly negotiate key terms when sitting at the table with an MCO.
This is especially important in a market like New York State, where smaller, fragmented patient panels and competition within the community can make it difficult for any single FQHC to establish consistently favorable terms with MCOs. Coming together in innovative ways can equip all partners with the knowledge, administrative resources, and support they need to make the most of their opportunities.
Download our guide to dive deeper into the VBP Roadmap and how your FQHC can take advantage.
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