News Release: HSG Supports Amida Care Health Plan and EngageWell IPA to Submit New York State’s First Level 2 VBP Arrangement for Shared Risk with Federally Qualified Health Centers

FOR IMMEDIATE RELEASE: Thursday, February 18, 2021
Contact: David Belsky; dbelsky@goodrebellion.com; 347-227-0055

Albany, NY – HSG announced today that as a result of their successful partnership with Amida Care and EngageWell IPA, the two organizations are submitting a Level 2 Value-Based Payment (VBP) contract to the New York State Department of Health. The contract is New York’s first example of Federally Qualified Health Centers (FQHCs) taking on a more advanced role in the financing and management of quality care in a value-based environment. 

Amida Care is New York’s largest nonprofit Medicaid Special Needs Health Plan (SNP), and EngageWell IPA is a network of health and social care providers committed to using harm reduction to advance the health and well-being of patients.

“This is an exciting day for the move to value-based health care in New York State,” said Jason Helgerson, founder and CEO of HSG, and former NYS Medicaid Director. “Arrangements like this put FQHCs—which we know serve challenging patient panels exceptionally well—in the driver’s seat and gives them the ability to chart their own path to success. HSG is proud to have supported this contract negotiation.”

Chief Solutions Officer Juliette Price served as the lead negotiator between both parties, helping to structure the value based contract to meet the needs of both plan and provider. 

“Building a value based contract between parties is a key service that HSG offers and I’m proud of the work we completed for these clients. For high-cost, special-need populations, value based arrangements must be carefully built in order to not incentivize the wrong types of interventions–too broad of an arrangement could have negative consequences for this type of vulnerable population. This kind of speciality value based contracting is an area that HSG specializes in, and we are proud to see this contract be submitted for approval,” said Juliette Price, Chief Solutions Officer at HSG. 

The groundbreaking arrangement focuses on a panel of patients living with HIV who are Amida Care members and receive their primary care services at Housing Works, an FQHC that addresses the dual crises of HIV and homelessness. The VBP arrangement is tailored to incentivize both higher levels of health outcomes (primarily focusing on higher levels of viral load suppression and 14 other clinical indicators) and reducing total cost of care. 

This arrangement includes several innovative features including a pre-payment capitation to Housing Works for the provision of primary care and behavioral health services, giving Housing Works maximum flexibility to place the patient at the center of their care. It also allows for the ability to provide social determinants of health (SDOH) interventions as managed care benefits—nutrition support that includes medically-tailored meals and food packages, as well as advanced medication management and adherence support. 

“We are thrilled to be leading the way for innovative value-based payment design in New York State,” said Doug Wirth, President and CEO of Amida Care. “This arrangement will further align the health plan and providers to deliver high-quality care that improves population health for people with chronic conditions like HIV. It will advance goals to increase viral suppression, decrease avoidable, costly hospitalizations, transition members into coordinated primary and behavioral outpatient care, and provide access to nutritious food and other social supports that are essential for improved health outcomes. We are looking forward to the success of this model and are optimistic that this kind of fiscal arrangement will expand to include more providers.” 

“As previous co-chair of the New York State VBP Social Determinants of Health (SDH) and Community Based Organizations (CBO) Subcommittee, this is exactly the kind of flexibility that we knew would be available to providers as New York State moved towards a value-based health care system,” said Charles King, CEO of Housing Works. “It is so exciting for Housing Works to be on this cutting edge, and I know that we will deliver higher-quality services and reduce total cost of care, now that the incentives are aligned for both provider and payer.”

“The infrastructure needed to succeed with this kind of arrangement is exactly why EngageWell IPA gathered a network of providers that all share the same goal—to offer coordinated, integrated treatment options that include addressing social determinants of health,” said Kevin Muir, Executive Director of EngageWell IPA. “Ongoing investment is needed to achieve long-term success.” 

About HSG
HSG is a consulting firm that takes a multi-disciplinary approach toward creating disruptive solutions in health care and the social sector. We seek to drive our clients to implement real, measurable, scalable solutions to some of the world’s most wicked challenges. Learn more about how HSG can help you make the world a better place at www.hsg.global. 

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