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Accountable Care

In alignment with federal, state and payer-led initiatives, the Institute is in the process of transforming our clinical and financial operations to achieve the “Triple Aim” of better health care, better patient experience and lower costs. This effort builds on our prior successes as an “early adopter” of emerging health care innovations: we were the first FQHC in the state to achieve the highest level of patient-centered medical home (PCMH) recognition available from NCQA, and one of the first health centers in the country to implement an EHR system.

Along with two other New York State FQHCs, we operate FamilyHealth ACO, a Medicare Accountable Care Organization, serving over 7,000 Medicare beneficiaries in New York City and the Hudson Valley.

In the Mid-Hudson Valley, the Institute leads the Ulster County Health Home, which works to ensure that Medicaid beneficiaries with chronic conditions have access to and coordination of primary and acute health services, behavioral health care and long-term services and support.

The Institute also participates in a Manhattan/Bronx focused Medicaid Health Home known as CCMP, the Community Care Management Program. CCMP is a service model where a diverse network of organizations, including other community health centers, communicate and collaborate with one another so patients’ needs are addressed in a comprehensive, coordinated manner. The Health Home participating organizations work collaboratively to advocate for service and policy changes to improve the health of residents.

The Institute is also an active member of three Performing Provider Systems – one in each of the geographic areas we serve. These PPSs were formed as part of the New York State DSRIP (Delivery System Reform Incentive Payment Program) with a goal of improving care for patients on Medicaid while reducing emergency room use and inpatient stays. This project will help achieve these goals by reducing the use of emergency departments for preventable dental emergencies.