Chicago-based Medical Home Network (MHN), a nonprofit organization focused on transforming care in the safety net, partners this year with 64 federally qualified health centers (FQHCs) in seven states to participate in two CMS value-based programs: ACO REACH and the Medicare Shared Savings Program (MSSP).
MHN provider partners participating in NeueHealth Premier ACO achieved $10.1 million in gross savings and a 100 percent quality score in performance year 2022.
This will be MHN’s first year participating in the MSSP and second year in the ACO Realizing Equity, Access and Community Health (REACH) model. Together, these ACOs will cover nearly 50,000 Medicare lives.
MHN supports care transformation by helping FQHCs develop whole-person care coordination capabilities at the practice level, driven by real-time AI-powered insights and analytics that provide a complete picture of patient health. patient.
In an interview with health innovation, Cheryl Lulias, president and CEO of MHN and CEO of Medical Home Network REACH ACO, said, “I think there’s a really important story here about FQHCs embracing value-based care. I think it is vital for its future sustainability.”
He said MHN has always partnered with FQHC. “We have always recognized its value to the safety net,” Lulias added. “They care for more than 30 million Americans. One in 11 Americans receive care from an FQHC, so they are a really important segment. People ages 65 and older are the fastest-growing patient cohort they serve. “We recognized through our work that FQHCs needed a value-based care strategy for Medicare.”
Lulias noted that before the pandemic, FQHCs were excluded from many values-based programs. “They are now included because CMS has been very intentional with its macro goals of 100 percent traditional Medicare in value-based care by 2030 and 50 percent in Medicaid,” she said. “FQHCs are a huge segment and CMS is working to provide them with enabling programming and funding to get them on the path to value-based care. “It’s a paradigm shift, which is really exciting.”
Seventeen FQHCs in California, Illinois, Indiana, Michigan, and New York make up the Medical Home Network Health Alliance ACO, MHN’s new MSSP ACO that began in 2024. Lulias also serves as CEO of this ACO.
One of its MSSP partners is Eisner Health, which provides medical and dental services in Central, South Los Angeles, and the San Fernando Valley in California to low-income individuals and families.
“For nearly 104 years, Eisner Health has provided high-quality, coordinated care to our patients. Joining the Medicare Shared Savings Program with MHN will allow us to further develop our care management processes, collaborate with community health centers across the country, share and learn best practices, and improve the health and well-being of our Medicare payment for service. patients,” Warren Brodine, president and CEO of Eisner Health, said in a statement. “MSSP fits perfectly with Eisner Health’s mission. Together, we will improve the health and well-being of the communities we serve,” he added.
Lulias explained that MHN was founded in 2009 and more than 10 years ago created a technology platform to enable coordinated workflows and communication and better handoffs between different members of the delivery system. They were one of the first to adopt admission, discharge and transfer (ADT) notifications, for example.
“Medical Home Network started very focused on Chicago to try to create a better, more coordinated delivery system with the goal of transforming care and improving safety net health,” he said.
Over the years, they refined the model, and when Illinois moved to Medicaid managed care, MHN developed the capabilities and infrastructure to manage the full risk in a Medicaid ACO.
“We have created care teams at the practice level. They are employed and integrated into primary care practices,” Lulias said. “These care teams, a combination of licensed and unlicensed teams, manage patients throughout the continuum, in all locations and settings. We work to create a system that works harmoniously at the service of the patient. We have achieved measurable results, demonstrating that building trusting relationships with patients at the primary care level while driving technology-enabled care and clinical transformation in a culturally sensitive way, focusing on the whole person, truly drives better care and better results.”
He said that because of their success in Chicago, they wanted to have a greater national impact. “We started expanding from Chicago to other markets and that’s where this partnership with NeueHealth started and we moved from Medicaid to Medicare.”
Lulias said MHN has found FQHCs to be very receptive to participating in ACO REACH and MSSP, because they have always focused on whole-person care. “They have always recognized the importance of mitigating social determinants to improve health, and value-based care is really aligned with their model of care,” she said. “I think FQHCs appreciate the flexibility to innovate and utilize the care team in a value-based care structure. “FQHCs understand the importance of moving away from fee-for-service and the flexibilities that alternative payment models provide to fund the exceptional care they provide.”
