One of the stated goals of federal healthcare policymakers is to engage more community health centers in value-based care programs. Startup company Yuvo Health shares that goal. It has just announced that four Federally Qualified Health Centers (FQHCs) in New York have joined its independent provider association (IPA): Long Island Select Healthcare, Metro Community Health Centers, Joseph P. Addabbo Family Health Center, and Advantage Care Health Centers.
In an interview, Cesar Herrera, CEO and co-founder of Yuvo Health, said the company contracts directly with health plans such as Medicaid managed care organizations, enabling FQHCs to participate in these contracts, most of which would have been unable to qualify on their own.
“We are a tech-enabled administrative and managed care contracting engine, specifically for Federally Qualified Health Centers, and specifically to support their transition toward value-based care,” he said. “We've been in operation for about a year now, and we've raised about $7.5 million in outside venture capital to enable us to launch our services and support the model, which we have launched in the New York City area, and we now have four pilot FQHC partners.”
Herrera noted that policies at both the state and national levels are moving toward including FQHCs and similar providers into value-based care models. “However, they fail to recognize the lack of infrastructure to support FQHCs in that journey. As a result, FQHCs are several steps back, not through any fault of their own. Our goal at Yuvo is to support the FQHCs from the infrastructure side so that they can get credit for the work they are already doing.
Miriam Vega, Ph.D., is CEO of the Joseph P. Addabbo Family Health Center, an FQHC with five clinics in areas of New York City that are vastly underserved. Vega has served as a turnaround specialist at several FQHCs. “I am brought into FQHCs to help turn them around. I was previously in Los Angeles, where they have moved forward with value-based payments at a much faster rate than the East Coast has, so I'm very familiar with this,” she says. “Part of my turnaround plan here is to be part of this value-based payment infrastructure, and I want to be data-driven. That's partly why I'm also very attracted to this new partnership with Yuvo, because it's going to enhance our ability to be data-driven and better pinpoint the needs of our patients.”
She said Addabbo needs assistance in terms of its contract management with the managed care organizations. “We need access to better real-world data. We want to provide whole-person care, and we want to enhance our services — everything from behavioral health to managing chronic diseases, such as diabetes and heart disease, which are very high in our communities,” she said. “Access to this type of infrastructure and allowing us to do better care management and chronic disease management will greatly improve the health of our communities.”
Medicaid is the largest percentage of the payer mix for an FQHC, and Herrera said everything that Yuvo is working on right now involves contracting directly with Medicaid managed care organizations. “But we are intentionally looking at supporting our equity partners across all lines of business for all patient populations, Medicaid, Medicare, and commercial,” he added, “so that as many patients that flow through the doors of an FQHC are attributed to value-based care, then we'd get revenue accordingly through those models. Yuvo acts as the contracting intermediary, and we contract directly with managed care entities.” FQHCs are prohibited from taking on downside risk, which also greatly limits the opportunities that they independently have for greater shared savings models, he said. Yuvo takes on that downside risk.
Yuvo is looking to expand, Herrera said, because it needs to have scale in order to be able to support its partners appropriately. “The way that we can get that is by making sure that we have as many attributed lives in these contracting vehicles as possible. Since we're building out pretty significant infrastructure — both technical and human resources — to support our community partners, we can only do that if we have meaningful operations that are being supported underlying under that initial infrastructure. We are in the New York area — there are nearly 7.5 million Medicaid lives in the state of New York alone. And we have five target markets outside of New York that we are currently pursuing, which are Ohio, Michigan, New Jersey, Pennsylvania, and Maryland.”
I asked Herrera if there is something specific about those states that make them attractive targets.
From a policy standpoint, they are all Medicaid managed care states that have meaningful alternative payment models and have 1115 waivers or other value-based care initiatives or standards that are baked into them, he replied. “They have significant competitive environments for health plans that we’re then able to leverage in order to contract appropriately, as well. In the case of Ohio, and soon in Michigan, there is Medicaid re-procurement and with expectations of increasing the requirements around value-based care models in the Medicaid space.”
Vega said the value-based care contracts allow FQHCs to address social issues impacting patients’ health. “In New York City, a lot of FQHCs don't use the community health worker model yet, which I'm used to in California,” she said, “and I would love to be able to hire some of those here to help with that. They bridge our services with community-based organizations to address food insecurity, housing, insecurity, and enhancing behavioral health. We're hoping to use some of the enhanced revenue to build out our behavioral health unit even more and integrate it further, and have a model where patients have a care team made up of their provider and a behavioral health specialist working hand in hand together. Our goal for the next two years is to build that out.”
Herrera said that as a country we have to do a better job of supporting FQHCs. “I can never say enough just how critical a role FQHCs play in the communities that they serve,” he said, citing Addabbo as a prime example. It is the only primary care provider in all of the Far Rockaways, and that is not an uncommon thing for FQHCs across the country. “If we don't create sustainable financial models for FQHCs, then we stand to lose a critical safety net institution and infrastructure across the board. We're already at risk of that,” he said. “There are 20 million individuals across the country who need access to primary care, because they're in Medicaid and low income but do not have access to an FQHC. The reason Yuvo was built is to increase access to sustainable revenue sources for FQHCs.”