Project Name: Primary Care & Behavioral Health State Learning & Action Collaborative

Project Overview:

The Delivery System Reform Incentive Payment (DSRIP) program is the main mechanism by which New York State sought to implement the Medicaid Redesign Team (MRT) Waiver Amendment. The intention of DSRIP was to reinvest in the Medicaid program, with the primary goal of reducing avoidable hospital use by 25% over 5 years and achieving defined results in system transformation, clinical management, and population health. In its fifth and final year, the DSRIP program increasingly focused on rewarding collaboration between providers and on transitioning providers to Value Based Payment (VBP) arrangements. Supported by funds from The Delta Center for a Thriving Safety Net and RCHN Community Health Foundation, CHCANYS and the NYS Council for Community Behavioral Health (NYS Council) collaborated to identify policy synergies among community health centers (CHCs) and behavioral health organizations, and worked together to develop member capacity in the transition to VBP and integrated care. During the initial project period, CHCANYS identified policy and regulatory barriers to care integration and facilitated member dialogue regarding value-based payment contracting incorporating both behavioral health and primary care.

The project coincided with the global public health emergency brought on by the rapid proliferation of COVID-19. In response to the COVID-19 pandemic, many community health centers shifted virtually overnight to conducting patient visits via telehealth. Federal and State flexibilities granted during the COVID-19 public health emergency, including reimbursement for in-person and video visits, drove care delivery in new directions. Seeking to build on the rapid expansion of remote care delivery and ensure ongoing support for and successful implementation of telehealth beyond the pandemic, the second stage of the project focused on evaluating the provider and patient experience with telehealth during the pandemic, and understanding how these might affect post-COVID care.

CHCANYS goal in year one was to position health centers throughout New York State to build strong cross-sector partnerships and succeed in a VBP environment.

Year-one project objectives were to:

  • Promote collaboration across and between CHCs, and between CHCs and behavioral health care providers;
  • Support the ability of the state’s health centers to provide high quality care;
  • Build thriving partnerships across the primary care and behavioral health sectors;
  • Advance policy changes that incentivize collaboration and service integration;
  • Develop model for data sharing; and
  • Foster practices of a learning organization.

Year One Project Activities:

  • Established a multidisciplinary advisory committee comprised of behavioral health providers and FQHCs to inform the project effort and advance the policy integration goals;
  • Documented and assessed the range of existing VBP arrangements;
  • Convened two rounds of in-person regional meetings of CHCs and behavioral health providers;
  • Convened CHCANYS members, NYSC members, policymakers, payers and industry thought leaders for a half-day meeting focused on VBP implementation and models for integrating care;
  • Based on best practices shared at Delta Center convenings, developed new, common resources for behavioral health and CHC providers; and
  • Offered webinars, fact sheets and toolkits to enhance learning.

Year One Project Outcomes:

  • In partnership with the NYS Council for Community Behavioral Healthcare, promoted collaboration and group learning among health centers and behavioral health organizations by convening: three regional collaborative meetings throughout NYS in Manhattan, Rochester, and Albany; a meeting between Behavioral Health Care Collaboratives (BHCCs) and health center-led independent practice associations (IPAs); and an Integrated Care Summit with attendees from behavioral health organizations, health centers, health center IPAs, and BHCCs;
  • Established a learning collaborative to highlight best practices regarding clinical integration models, data sharing tools, and governance;
  • CHCANYS and the Council provided coordinated responses to State’s DSRIP 2.0 waiver amendment request, recommending that the State dedicate at least 25% of DSRIP funds to community-based Value-Driving Entities where health centers and/or behavioral health organizations are the lead entity;
  • Submitted comments on the Federal Government’s proposed changes to 42 C.F.R. Part 2, Confidentiality of Substance Use Disorder Patient Records. Comments submitted by CHCANYS and many other key stakeholders led to important changes to the rule to better facilitate care integration among federally-assisted programs and promote whole-person health care; and
  • In response to a need identified by the advisory committee, CHCANYS presented an FQHC 101 webinar to help behavioral health partners better understand the landscape in which CHCs work.

During the second project phase, CHCANYS intends to demonstrate the benefits of telehealth for patients and providers to ensure ongoing telehealth investment beyond the end of the COVID-19 emergency.

Working with investigators at the NYU Grossman School of Medicine (NYUGSoM), Department of Population Health, CHCANYS will conduct interviews with providers and patients in NYS FQHCs and Look-alikes (LALs). These interviews will seek to understand:

  • How do providers view telehealth?
  • How should telehealth be used post-pandemic? What are the appropriate clinical workflows?
  • Are patients interested or eager to continue receiving remote care? What modalities do they prefer for which services?
  • What are the limiting factors for patients to utilize telehealth?
  • How does telehealth address or exacerbate existing disparities?

Issues related to access, quality, payment, and equity, which are of great importance to policy makers and managed care organizations, will be incorporated in the interview protocols. The findings from these interviews will be used to produce a study that demonstrates the benefits of telehealth for patients and providers to ensure ongoing investment in telehealth. The audience for this study includes the State Medicaid office and Medicaid managed care plans, as well as community health center organizations in other states.

Project Partners: New York State Council for Community Behavioral Healthcare (NYS Council), a statewide nonprofit membership association representing the interests of nearly 100 behavioral health (mental health and substance abuse) prevention, treatment and recovery organizations across New York, and the NYU Grossman School of Medicine (NYUGSoM), Department of Population Health.

About the Grantee

The Community Health Care Association of New York State (CHCANYS) was established to give a voice to the state’s network of community health centers as leading providers of primary care. The oldest Primary Care Association in the country, CHCANYS today represents more than 70 community health centers that operate over 800 sites in every region of New York State. CHCANYS mission is to champion community-centered primary care in New York State through leadership, advocacy, and support of community health centers.