Refuah Health Center and Fidelis Care: Improving Quality and Aligning Financial Accountability
November 2, 2012
WebsiteSEE GRANT OUTCOMES
Refuah Health Center, a federally qualified health center (FQHC) that serves low-income residents in the Hudson Valley region, has spent considerable time and resources establishing the principles of the patient-centered medical home.
Refuah had intended to take more responsibility for the total care of its patients by accepting capitated or bundled payments from its key Medicaid payer. Fidelis Care, one of the largest Medicaid managed care plans in New York State, partnered with Refuah to implement new payment schemes that could lead to lower health care costs and higher quality services for its patients. However, Refuah lacked information on the utilization patterns of its patients outside of its center, including the cost of their emergency, specialty, and hospital care. With support from NYHealth, Refuah partnered with Health Management Associates (HMA) to analyze claims to identify unnecessary utilization and costs.
Under this grant, Refuah set out to establish a partnership with Fidelis Care and HMA to develop and implement a data-driven plan to improve patient outcomes and reduce costs for Refuah’s Medicaid managed care patients. The project would also align incentives and accountability between Refuah and Fidelis Care. Refuah also intended to implement clinical and operational practices at its center that support the improved model of care and financial accountability.
NYHealth originally awarded Refuah a grant of $198,800 to achieve these goals. During the course of the grant period, however, Refuah was unable to complete all of its grant activities. As a result, the final grant amount was revised to $159,040.