Northern Oswego County Health Services, Inc.

The shift from fee-for-service to value-based payment models places greater need for federally qualified health centers (FQHCs) to adapt to changes in the health care landscape.

For FQHCs to remain economically sustainable and continue delivering care to medically underserved areas, it is vital for them to develop and implement different strategies to keep their doors open. However, because of limited resources and influence, many FQHCs find themselves at a disadvantage, especially when it comes to negotiating terms with payers. Four FQHCs in Central York—spanning 14 delivery sites and operating 32 school-based health centers—had plans to establish the Upstate Community Health Collaborative Independent Provider Association (UCHC IPA). The formation of an IPA would allow providers to negotiate contracts with insurance companies, exerting an influence on behalf of its members to counterbalance the leverage of health care insurers. In 2015, NYHealth awarded Northern Oswego County Health Services, Inc., as fiscal sponsor to UCHC IPA, a grant to support the implementation of a business plan and offset some of the associated first-year ramp-up costs with the IPA.

Under this grant, UCHC IPA worked to secure meaningful contracts with payers and other types of providers, maximizing new reimbursement models to strengthen the participating FQHCs financial sustainability. Specifically, UCHC IPA applied for tax-exempt status with the IRS; assesed and implemented budgets; developed participating provider contract and agreements; and reviewed and assessed a range of regulatory, legal, and contractual issues on forming an IPA. With an increased capability to assume financial risk, UCHC IPA will had the flexibility to evolve with health care reforms, ensured the financial sustainability of its partners, and streamlined delivery services to provide high-quality care at low cost.