Advancing Primary Care

Grantee Name

Upstate Community Health Collaborative IPA (Fiscal Sponsor: Northern Oswego County Health Services, Inc.)

Funding Area

Advancing Primary Care

Publication Date

November 1, 2018

Grant Amount

$150,000

Grant Date:

December 2015 -- November 2017

The shift from fee-for-service to value-based payment models means federally qualified health centers (FQHCs) must adapt.

For FQHCs to remain economically viable and continue delivering care to medically underserved areas, they need to develop and implement different strategies to keep their doors open. However, because of limited resources and influence, many FQHCs find themselves at a disadvantage, especially when it comes to negotiating terms with payers.

Four FQHCs in Central New York—spanning 14 delivery sites and operating 32 school-based health centers—set out to establish the Upstate Community Health Collaborative Independent Provider Association (UCHC IPA). The formation of an IPA would allow providers to negotiate contracts with insurance companies, exerting greater influence on behalf of its members and potentially spreading risk.

NYSHealth awarded Northern Oswego County Health Services, Inc., as fiscal sponsor to UCHC IPA, a grant to support the implementation of a business plan and offset some of the associated first-year ramp-up costs to form an IPA.

Outcomes and Lessons Learned

  • Developed a uniform set of metrics, policies, and procedures for value-based payment contract implementation for UCHC IPA, which all four participating FQHCs agreed upon.
  • Secured and signed a value-based payment contract with Fidelis starting January 1, 2018.

Under New York State’s Delivery System Reform Incentive Payment (DSRIP) program, payers and providers must adopt new contracts that embed value-based elements. The contracts exhibit different levels of risk so that providers can gradually accept increased amounts of financial risk. Fidelis Care and UCHC IPA originally signed a level-1 contract with a start date of July 1, 2017. Because of a delay in acquiring data and mutual misunderstanding, they pushed the start date of their contract until January 1, 2018. By the close of 2018, UCHC IPA will complete the first year of a level-1 value-based payment arrangement with Fidelis Care, and is renewing its contract for the following year. Additionally, UCHC IPA is negotiating a two-year level-1 arrangement with United HealthCare.

UCHC IPA has since added a new provider member, Regional Primary Care Network, extending its reach beyond the city of Rochester and stretching south into the Finger Lakes region and east into the city of Utica.

UCHC IPA is also partnering with the Central New York Care Collaborative, which in turn is partnering with IBM Watson Health to create a population health management platform to connect more than 2,000 health care and community-based providers across six counties in Central New York. The platform is designed to help improve health for residents across the region, with the goal of reducing avoidable hospital use by 25%.

Finally, UCHC IPA has been active in the initial development of the Central New York Behavioral Health Care Collaborative (CNYBHCC), which will help behavioral health providers in the region engage in value-based payment arrangements and improve the integration of physical and behavioral health care. Once the CNYBHCC network is formed, UCHC IPA will be a participating provider.

The formation of this FQHC-led IPA and its early endeavors with value-based contracting help lay the groundwork for a larger-scale move by FQHCs across the State to embrace newer reimbursement models that reflect value over volume.

Co-Funding and Additional Funds Leveraged:The Health Foundation for Western and Central New York contributed $55,000, in addition to $70,000 provided during a previous phase of this project. Four UCHC IPA health centers agreed to contribute $30,000 each for 2015 and 2016.