NYHealth awarded Refuah a grant to establish a partnership with Fidelis Care and HMA to:
- Develop and implement a data-driven plan to improve patient outcomes and reduce costs for Refuah’s Medicaid managed care patients;
- Align incentives and accountability between Refuah and Fidelis Care
- Implement clinical and operational practices at Refuah that support the improved model of care and financial accountability.
Without notifying NYHealth, Refuah made several project changes over the course of the grant period that significantly altered the project’s original purpose and scope of activities:
- HMA, a lead partner, left the project;
- Data received from Fidelis Care were deemed inaccurate by Refuah, and therefore could not be used as initially envisioned for the project;
- No clinical or operational practices for improvement were identified; and
- Focus of the project was changed without NYHealth’s approval to a value-based dental pilot program, which differed significantly from the grant’s original focus to improve outcomes and reduce costs in key clinical cost categories for Refuah’s Medicaid managed care patients.
Additionally, Refuah was unable to complete or deliver significant grant activities as outlined in the original project scope, including:
- Project implementation and work plans with details on key findings/activities, major milestones/responsibilities, and evaluation/performance-monitoring activities; and
- A summary report to be developed with Fidelis Care highlighting the processes, outcomes, major obstacles, and solutions of the project. The report was intended to serve as guidance for other organizations interested in pursuing a similar strategy.
Although this grant helped Refuah to establish a quality reporting and data analysis system, as well as position it to successfully apply as a lead Performing Provider System, it did not meet its intended grant goals and activities.
NYHealth made several unsuccessful attempts to contact Refuah to discuss the changes to the grant’s scope. As a result, NYHealth canceled the grant and did not distribute the final payment.
