Medical Residence Community Companions With 17 FQHCs on MSSP ACO

Chicago-based Medical Residence Community (MHN), a nonprofit group targeted on reworking care within the security internet, is partnering this 12 months with 64 federally certified well being facilities (FQHCs) in seven states to take part in two CMS value-based applications: ACO REACH and the Medicare Shared Financial savings Program (MSSP). 

MHN supplier companions collaborating within the NeueHealth Premier ACO achieved $10.1 million in gross financial savings and a 100% high quality rating within the 2022 efficiency 12 months.

This would be the first 12 months MHN participates within the MSSP, and the second 12 months collaborating within the ACO Realizing Fairness, Entry and Group Well being (REACH) Mannequin. Collectively, these ACOs will cowl almost 50,000 Medicare lives. 
 
MHN helps care transformation by serving to FQHCs construct whole-person care coordination capabilities on the apply degree — powered by AI-driven, real-time analytics and data that provides a full image of a affected person’s well being.

In an interview with Healthcare Innovation, Cheryl Lulias, president and CEO of MHN and CEO of the Medical Residence Community REACH ACO, mentioned, “I believe there’s a extremely massive story right here about FQHCs embracing value-based care. I believe it is important to their future sustainability.” 

She mentioned MHN has at all times partnered with FQHCs. “We have at all times acknowledged their worth to the protection internet,” Lulias added. “They deal with over 30 million Individuals. One in 11 Individuals receives their care from an FQHC, so they seem to be a actually vital section. Folks 65 and older make up the fastest-growing cohort of the sufferers they serve. We acknowledged by means of our work that FQHCs wanted a value-based care technique for Medicare.” 

Lulias famous that earlier than the pandemic, FQHCs had been excluded from many value-based applications. “Now they’re included as a result of CMS has been very intentional with their macro targets of 100% of conventional Medicare in value-based care by 2030 and 50 % in Medicaid,” she mentioned. “FQHCs are an enormous section, and CMS is working to supply the facilitative programming and financing to allow them to get on the value-based care path. It’s a paradigm shift, which is absolutely thrilling.”

Seventeen FQHCs in California, Illinois, Indiana, Michigan and New York make up Medical Residence Community Well being Alliance ACO, MHN’s new MSSP ACO that began in 2024. Lulias additionally serves as CEO for this ACO.

One in all its MSSP companions is Eisner Well being, which supplies medical and dental providers in downtown, South L.A. and the San Fernando Valley in California to low-income people and households. 

“For nearly 104 years, Eisner Well being has offered high-quality, coordinated look after our sufferers. Becoming a member of the Medicare Shared Financial savings Program with MHN will permit us to additional develop our care administration processes, collaborate with neighborhood well being facilities throughout the nation, share and study greatest practices, and enhance the well being and well-being of our fee-for-service Medicare sufferers,” mentioned Warren Brodine, president and CEO of Eisner Well being, in an announcement. “MSSP matches completely with Eisner Well being’s mission. Collectively, we are going to enhance the well being and well-being of the communities we serve,” he added.

Lulias defined that MHN was based in 2009, and greater than 10 years in the past it created a expertise platform to allow coordinated workflows and communication and higher handoffs between totally different members of the supply system. They had been an early adopter of admission, discharge and switch (ADT) notifications, for example. 

“Medical Residence Community began hyper-focused on Chicago to try to create a greater, extra coordinated supply system with the objective of reworking care and bettering the well being of the protection internet,” she mentioned. 

Through the years, they refined the mannequin, and when Illinois moved to Medicaid managed care, MHN constructed the capabilities and infrastructure to handle full danger in a Medicaid ACO.

“We have constructed care groups on the apply degree. We’ve got care groups that handle on the elbow of major care,” Lulias mentioned. “These care groups — a mixture of licensed and unlicensed — handle sufferers all through the continuum, throughout all venues and settings. We work to create a system that works harmoniously in service of the affected person. We’ve had quantifiable outcomes, which present that constructing trusting relationships with the sufferers on the major care degree whereas driving care and scientific transformation enabled by expertise in a culturally delicate method, specializing in the entire individual, actually drives higher care and higher outcomes.”

She mentioned that due to their success in Chicago, they wished to have extra of a nationwide affect. “We started increasing from Chicago to different markets and that is the place this partnership with NeueHealth began, and we went from Medicaid to Medicare.”

 Lulias mentioned that MHN has discovered FQHCs very receptive to collaborating in ACO REACH and MSSP, as a result of they’ve at all times been targeted on whole-person care. “They’ve at all times acknowledged the significance of mitigating social determinants to enhance well being, and value-based care is absolutely aligned with their care mannequin,” she mentioned. “I believe FQHCs recognize the flexibleness to innovate and use the care crew in a value-based care assemble. FQHCs perceive the significance of shifting away from charge for service and the flexibilities that different fee fashions present to finance the distinctive care they provide.”