There are about 1,400 Federally Certified Well being Facilities (FQHCs) within the U.S. offering care to Medicare, Medicaid and uninsured sufferers in underserved communities—a one-stop-shop security web for well being and wellness that expenses a sliding scale. So it won’t come as a shock to study they lack the assets to assist everybody who wants their providers. Actually, about 20 million or so low-income individuals don’t have entry to a FQHC, in keeping with Cesar Herrera, CEO and co-founder of Yuvo Well being.
“They’re vital for low-income individuals, however there aren’t sufficient of them,” he says.
That’s why, a few 12 months in the past, Herrera and three co-founders launched their startup with a mission of giving FQHCs entry to extra revenues and the wherewithal to increase their attain.
Worth-Primarily based Care
All of it pertains to the transfer by coverage makers and well being plans to value-based care and away from payment for service reimbursement programs. The strategy goals to carry down the price of care, partly, by making certain individuals get the providers they want early on, so that they don’t wind up within the ER, both as a result of they’ve nowhere else to go, their circumstances have worsened attributable to insufficient care or they’ve underlying psychological well being points that ought to have been managed extra successfully by major care.
How to verify individuals get the care they want earlier than their circumstances worsen? The reply is shared financial savings—that’s, financial savings shared between physician and well being plan—and revamping the incentives for major care docs, since they’re the primary line of protection ensuring sufferers get the correct care on the proper time. Thus, underneath a value-based care system, major care docs earn extra money for holding monitor of the assorted providers their sufferers want, ensuring they obtain acceptable care and reporting all that to well being insurers. Plus there are added incentives hooked up to preventive providers.
However making that occur requires a brand new set of working necessities. That’s, major care docs want a option to get entry to and report related affected person data. “A complete new equipment must be constructed to help that mannequin,” says Herrera.
What does this imply for FQHCs? To maneuver into value-based care, they face a number of boundaries. First, they should construct a brand new infrastructure and plenty of don’t have the assets to take action. Plus, lots of them aren’t massive sufficient to compete. And so they face regulatory limitations. Particularly, they’re prohibited from collaborating in sure probably profitable fashions the place there’s a draw back threat.
Addressing these boundaries is Yuvo Well being’s mission. To that finish, it has a world contracting system enabling FQHCs to affix in combination, with Yuvo negotiating contracts on behalf of all taking part well being facilities. So FQHCs that may have been too small to qualify for these contracts are actually eligible, as a result of the corporate negotiates for the collective.
Then there’s the matter of how pricey it’s to construct the mandatory reporting, knowledge analytics and knowledge aggregation infrastructure. The corporate’s managed providers system has an administrative element that takes care of all reporting, in addition to affected person engagement and outreach, transition to care coordination and threat adjustment. “They’re all desk stakes features wanted to function a value-based care engine,” says Herrera. As a result of it’s centralized, the system can help a number of FQHCs.
As for draw back threat, since Yuvo isn’t an FQHC, it isn’t ruled by the identical laws. Consequently, the corporate can tackle the draw back threat on behalf of its clients. That, in flip, unlocks extra profitable value-based care preparations for taking part FQHCs they in any other case wouldn’t be capable to faucet.
Additionally, the FQHCs don’t pay the corporate, so there’s no price to them. As a substitute, Yuvo receives a share of the shared financial savings achieved within the back-end. If there are not any financial savings, then the corporate doesn’t receives a commission. The upshot: FQHCs face little threat, whereas having access to extra income.
“Each new greenback that comes within the door will not be padding investor wallets,” says Herera. “It goes straight into serving the neighborhood—all the pieces from hiring extra docs to growing hours of operation.”
Impressed by Private Expertise
Herrera spent his profession in well being care technique and operations for Medicaid, Medicare and business firms. However he and his and his co-founders, who even have a background in managed care, obtained the concept for the startup from their very own experiences as Medicaid or FQHC sufferers.
As a baby rising up in southeastern Michigan, for instance, Herrara didn’t all the time have medical health insurance. However there was a FQHC. It wasn’t till a few years later that he realized how a lot the group had finished for his household and his neighborhood. “It was an extremely highly effective realization that, if I had not entry to this FQHC, I might not have had entry to care, until I went to the ER,” he says.
When Covid hit, Herrera and his co-founders determined it was time to make the leap and launch their startup. They shaped the corporate with not way more than an thought. Then in April, they closed on a spherical of about $1.3 million that allowed them to begin constructing out the system. They simply closed on their subsequent spherical of $6 million. The preliminary market is in downstate New York, the place they’ve signed contracts on behalf of their FQHC companions with varied well being plans. Whereas Herrera says he can’t disclose specifics, the objective is to have contracts overlaying 25,000 Medicaid members by the tip of this quarter .
After establishing a monitor report, Yuvo plans to maneuver to the remainder of New York, the place there are totally different well being plans to deal with, after which to different markets in Michigan, Ohio, Pennsylvania and New Jersey.