by Barbara Faron

Federation of Organizations is a not-for-profit corporation providing a range of services designed to support individuals in acquiring the skills and information required to achieve self-affirming outcomes as they meet life’s challenges.  Federation was incorporated in 1972 by family members of people living in psychiatric hospitals with the goal of improving conditions in the institution and developing support services in the community for individuals upon their release.  Through the years, we have broadened our scope and have developed an array of services designed to support people in their effort to achieve their goals as productive members of their community.

Through this blog, we hope to encourage a public conversation and provide information about issues that impact our communities and lives, ranging from discussions regarding public policy to useful information on a range of topics from wellness to financial management.    This inaugural blogpost will discuss one trend reshaping the healthcare landscape: the transformation of the healthcare system to Value-Based Care, which has significant implications for the funding and strategic direction of Federation of Organizations’ services and mission.

While the expansion of Medicaid eligibility under the Affordable Care Act has increased the number of people who have access to health insurance, the fragmented, fee-for-service system has proved to be costly, with outcomes that could be improved. New models are being piloted and implemented throughout New York and the U.S. to improve the overall care and wellness of our population. A major initiative of the New York State Medicaid redesign effort is the Delivery System Reform Incentive Payment (DSRIP) Program, which aims to help hospital systems move to the VBP system and collaborate with community-based providers as required by the Federal Government.

Medicaid, Medicare, and private insurance are moving to a coordinated system that pays for the outcomes of care (Value Based Payments-VBP) provided by groups of practitioners sharing information rather than individual services provided independently (fee-for-service), which tend to be fragmented and lacking a holistic perspective. As we approach individual health outcomes from a holistic, value-based perspective, it becomes clear that the social determinants of health (income maintenance, housing, education, social and family supports, transportation, health literacy, access to healthy food, and other resources that many of us take for granted) have an important influence on the outcomes of medical treatment.

The transition to VBP requires healthcare providers to transform the way they do business. Medical care cannot be given in isolation.  The social determinants of health impact healthcare outcomes.  Historically, helping individuals and their families access resources and navigate care was left to the community sector. Community-based programs like Federation have been relied upon to provide the social determinants of health with funding from outside the healthcare system. In order to achieve the goals of value-based care (improved outcomes, improved patient experience, and lower cost), under a VBP system healthcare providers must partner with each other and community-based providers outside of institutional boundaries.  It is a totally different way of doing business, and the transition is full of roadblocks and challenges.

Federation is an active participant in the transformation of the healthcare system.  One major initiative designed to improve care is Health Home Care Coordination which provides individual guidance and support and linkage to services for high-need users of healthcare. Federation has been providing Care Coordination as part of several Health Homes in the downstate area for the last five years.  Taking an integrated approach to service delivery, Federation is integrating primary care into some of its behavioral health settings in collaboration with the local DSRIP.  Another effort to improve and integrate care is the Independent Provider Association (IPA), which brings together an array of providers under a single administrative entity, enhancing accountability and coordination of services.  Federation is a principal in Advanced Health Network, an IPA in Suffolk County, and a provider in Coordinated Behavioral Care (CBC) an IPA in NYC. Since 1972 Federation has been responding to the change and has actively helped transform the system of care through the years. It is hoped that Value-Based Payment will encourage an integrated, holistic approach to the healthcare needs of the people we serve.