Advancing Primary Care Payment Reform in New York State
Special Projects Fund
December 10, 2018
Federally qualified health centers (FQHCs) provide cost-effective, culturally appropriate primary, preventive, dental, and behavioral health care services to patients, many of whom are from underserved and vulnerable populations.
FQHCs also integrate these care services with programs focused on addressing social determinants of health, such as housing, food security, and employment. However, existing investment in primary care services is not designed to sufficiently support this comprehensive care model. There is a need to better align funding structures by developing an alternative payment system to support sustained investment in comprehensive, community-based primary care. In 2018, NYHealth awarded the Community Health Care Association of New York State (CHCANYS) a grant to develop and implement an alternative payment methodology (APM) for FQHCs in New York State.
Under this grant, CHCANYS worked to determine an alternative payment system that will allow for FQHCs to be reimbursed under an APM. CHCANYS identified payment reform opportunities; aligned FQHCs and stakeholders behind a common strategy; assessed FQHC preparedness to enter into an APM; and piloted an APM model in the field. CHCANYS developed an APM model that is calculated on value rather than volume, advances payment reform, supports a care model that more fully addresses social determinants of health, and can be implemented statewide. It convened a payment reform summit to align its FQHC members behind a common strategy and shared goals for payment reform. A project team evaluated a draft APM model for financial sustainability and compatibility with FQHCs in New York State. CHCANYS then worked with the New York State Department of Health, Centers for Medicare & Medicaid Services, and a carefully chosen cohort of FQHCs to implement the APM and support practice transformation efforts.