Muskingum Valley Health Center: Embracing Value-Based Care in the Safety Net

Muskingum Valley Health Center (MVHC), a community health center with 13 locations in four rural counties in eastern Ohio, has jumped on the value-based care bandwagon and even created a value-based care department with 19 R.N. care managers. CEO Dan Atkinson recently spoke with Healthcare Innovation about MVHC’s participation in the ACO REACH model.

Joining the conversation was Misty Drake, vice president of client services and growth at Medical Home Network (MHN), a public benefit corporation focused on transforming care in the safety net by partnering with FQHCs on ACO REACH, the Medicare Shared Savings Program (MSSP), and other value-based care programs. MVHC is one of its parters. (In 2024, Healthcare Innovation interviewed Cheryl Lulias, president and CEO of MHN.)

Healthcare Innovation: Dan, could you talk about why Muskingum Valley is interested in these value-based care models? 

Atkinson: Value-based care is vital to the future of healthcare. We jumped on this model of care early on. Once patients have access to primary care, we can really start to create more value, which is going to save government and private payers money by improving access, and ultimately improving outcomes. Now we’re in this model where we're managing those elements that really drive cost.

HCI: Why did you choose to work with Medical Home Network on this? 

Atkinson: We felt that we had a shared vision of what it meant to do value-based care. They've been able to propel our value-based care model to where we wanted it, not only for the Medicare population, but we've been able to duplicate that for all populations.

HCI: Misty, has the number of FQHCs that MHN works with continued to grow? And could you talk about how you identify which community health centers are prime candidates to work with? Do they have to have a certain level of tech or analytics sophistication for it to make sense for you to work with them?

Drake: We are currently partnering with more than 80 health centers across eight states. We are very strategic in terms of how we grow those partnerships. We also work with primary care associations and FQHC-led IPAs. First of all, we ask: Are they ready to think about practice transformation? Because it's more than just implementing the model of care. It's more than just hiring the RNs. You really have to think through delivering care differently. Because you are looking at measures that health centers typically don't look at. 

What CMS or any of these value-based arrangements are looking at is reducing total cost of care. That's really the bottom line. They want you to manage utilization, and they want your patients to have appropriate utilization with their PCP practice. That requires you to think differently in terms of how patients access you. And Muskingum Valley has done a good job of thinking outside the box in terms of how patients access them for care when they need it the most.

HCI: Dan, has the use of embedded care managers changed how you interact with patients? Or are there other ways you have changed how patients can access the health center? 

Atkinson: There are a couple different ways, I think. One, we've leveraged technology. Even with the Medicare population, we are using active text messaging. Access is at the center of everything we do at MVHC, so we know that the easier we make access achievable, it is going to ultimately lead to lower cost, because most of the time when patients end up in the hospital for an unplanned admission or overutilize the ED, it's because they felt like, for some reason, they couldn't access their primary care provider. 
We try to make that as easy as possible. We always joke and say that the emergency room is our No. 1 competitor because it’s always there 24/7. Our patients are a little bit like water, seeking the path of least resistance. We need to make their path to accessing primary care as easy as it is to go to the emergency room. So we've done a couple of different things. We have urgent care that operates seven days a week. Even if they are seeing someone there other than their primary care provider, we have the record of those visits in our electronic medical record. That connectivity gives us the ability to treat that patient from a holistic standpoint.

 The other aspect, when I talk about technology, is knowing where and when our patients are accessing the emergency room or have an admission, and the follow-up that goes with it. So we're constantly reaching out to our patients after an unnecessary ER utilization to have a conversation and find out what prevented them from coming to the health center. If it was an admission that needed to happen, we're going to make sure that we do good follow-up care to keep them out of the hospital to avoid a readmission. 

HCI: Do you get ADT feeds from an HIE when one of your patients ends up in the hospital?

Atkinson: Yes, there’s a health information exchange that we're part of called CliniSync. It notifies us when a patient has been admitted to the hospital or been through the ER. And we work closely with our hospitals, too. We're able to leverage partnerships with the hospitals in our area, and we've got some joint efforts to try to really help manage that cost of care.

Drake: I think Dan touched on a really good point. One of the things that they've done really well has been around understanding when their patients are using the hospital and and having that 360-degree patient view, and taking into account that integrated medical, behavioral and social needs data. 

Oftentimes, what's a challenge for primary care providers is to be able to risk-stratify patients. Who do I need to get in now versus who do I need to get in later? That's something that we've worked with their team on — to really prioritize those patients who are at risk for readmission or for having another inappropriate utilization, so that they can manage the volume of ED alerts and inpatient alerts that come through and organize the team more effectively. The other thing, as Dan mentioned, is that strong hospital relationship. When you have a hospital that also wants to prevent readmissions, that is when you're cooking with gas, because you guys have a shared value in ensuring that that patient is actually getting the right care at the right time, at the right place.

Also, what works in rural Ohio could be very different from what works in rural Oklahoma. But the key is combining a proven model with the flexibility to adapt to the local context.That's how we've been able help health centers in very different settings achieve meaningful, sustainable change.

HCI: Can you talk about the results Muskingum Valley has been seeing in the ACO REACH program? 

Drake: When we first approached Muskingum Valley, we knew that it was likely to have a loss in the first year. One of the reasons why we wanted to work with them was that level of commitment to say this is a model that we want to embrace. They were already starting to engage in a lot of the practice transformation work, and we were pretty confident that as we worked together  we were going to be able to turn that around. So we were projecting that they were going to have a medical loss ratio of about 105% and I think, in the first year, they actually ended at 104%.

Within a year they decreased that medical loss ratio, and this year they're at 85%. That comes with a decrease in all costs — readmissions, lowering utilization across nearly all categories, and currently they are projecting to have about $2.2 million surplus by the third year. That really comes from the work of their team in getting patients more connected with their primary care providers.

HCI: Are there some challenges you have to work through with the practice to move to a more team-based approach? 

Drake: The beauty of it is that health centers have always provided some care management services. Adding components such as risk stratification has been relatively new, and that is a strong part of our model. The one thing that we have leveraged is extending the care team to take into account non-licensed individuals to help to support addressing social determinants of health. You really don't need a nurse to do that. So how do you bring in that next generation of healthcare workforce, starting them off doing care coordination activities, and having them really be a part of the care team? 

HCI: Dan, from your perspective, are there any other lessons learned that you would share with other community health centers?

Atkinson: I think that it's important when you venture down this value-based road to have a partner like an MHN, because they bring an element to the table that it's very hard as a health center to duplicate. Whether it's the technology aspect and the risk stratification best practices, and then the ability to take the data that comes in from CMS and put that in a reportable format that's understandable, not only to the business side of things, but also the clinical side of things. They also help with provider engagement. How do you motivate providers to think differently about how they deliver care?

It's so vital for health centers to go down this path because revenue streams are becoming more challenging, right? We're constantly dealing with the financial challenges as an FQHC. If we didn't have value-based revenue, we would not be able to continue to do what we do, and expand services and see more patients. This partnership has allowed us to springboard our entire program to the next level.