A new partnership between Yuvo Health, an administrative and managed-care solution for community health centers, and Centene subsidiary Fidelis Care aims to bring value-based care to federally qualified health centers in New York and its Medicaid population.
Value-based care is a system that incentivizes providers and insurance companies to bring down the cost of care and improve quality through shared savings between the two entities. Big health systems disproportionately have an advantage when it comes to value-based care because they have a larger scale and budget to make the changes, whereas community health centers and federally qualified health centers are at a disadvantage due to their smaller size, Yuvo Health CEO Cesar Herrera said.
In the partnership, which requires approval from the New York State Department of Health, Yuvo would be contracted with Fidelis through a value-based care arrangement where each side can tap into shared savings if certain goals are met. The partnership between these two New York City based organizations provides an opportunity to mitigate food, housing, transportation and socioeconomic insecurities that the patients of Yuvo Health’s FQHCs experience. It will focus on 13 clinical quality measures, including preventable hospital admissions, readmissions and emergency department visits. Four FQHCs are part of Yuvo Health’s independent provider association: Long Island Select Healthcare, Metro Community Health Centers, Joseph P. Addabbo Family Health Center and Advantage Care Health Centers.
Fidelis Care is New York’s largest Medicaid managed-care provider and has more than 2.4 million members statewide. Its size — and the fact that it’s statewide and not just in a certain region — drew Yuvo to the partnership, Herrera said. The company provides data and analytics tools, which would help Yuvo and its FQHC partners find performance gaps and make improvements. Yuvo Health will work with its FQHC partners and use Fidelis’ technology and analytics engine to meet contractual requirements and maximize shared savings.
Yuvo declined to state what the contractual obligations are given that those obligations are different for each FQHC.
The two-year partnership is starting at a Level 1, upside-only arrangement and then will transition to a Level 2 mitigated-risk arrangement, according to the news release. In a Level 1 arrangement, if there is a cost savings, then the provider would take a share of the cost saving. If there is a loss, the provider will not take a loss. In a Level 2 arrangement, if there is a loss, the provider would take on a loss. But if there is a savings, the provider would take on a larger percentage of the savings than in a Level 1 arrangement.
“This is what makes it so exciting for us: to be able to not just lock down this Level 2 contract, but to have it with our largest Medicaid managed care plan in the state,” Herrera said.
FQHCs are not able to take on Level 2 arrangements on their own, but because Yuvo Health qualifies, FQHCs have access through the partnership, Herrera said.
“Partnering with Yuvo Health ensures FQHCs can gain access to the technology and administrative support they need in order to thrive under value-based arrangements, which translates to better care for New Yorkers,” Pantelis Karnoupakis, vice president of value-based payment initiatives and risk adjustment at Fidelis Care, said in the news release. Fidelis Care did not respond to MedCity’s request for comment by the time of publication.
Herrera said Yuvo’s goal with the partnership is to prove that enabling FQHCs with value-based care can create savings and help provide more care to Medicaid and uninsured patients. Yuvo eventually hopes to expand this model outside of New York and across the U.S. with other health plan contracts.
“Our goal is to be able to establish as many of these relationships as possible for our FQHC partners because we want every patient to be attributed to some form of value-based care,” Herrera said.
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