Project Title
Advancing Primary Care Payment Reform in New York State
Grant Amount
$172,086
Priority Area
Special Projects Fund
Date Awarded
December 10, 2018
Region
Statewide
Status
Closed
Website
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 allows for FQHCs to be reimbursed under an APM. CHCANYS identified payment reform opportunities; aligned FQHCs and stakeholders behind common principles and strategies; assessed FQHC preparedness to enter into an APM; and built buy-in with government leaders. 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 in the future. It convened two payment reform summits 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 FQHCs to make recommendations for an APM model that supports practice transformation efforts, including advocating for the inclusion of an FQHC APM model in the State’s initial 1115 waiver amendment proposal.
Related materials for member FQHCs and other stakeholders: