The plan describes its approach as a glimpse into what the future of U.S. healthcare could look like.
Can a health plan be calibrated to achieve value-based results? Healthfirst and its latest patient outcomes across eight clinical areas suggest yes—and by making the community-based, health-equity infrastructure that has historically been missing from value-based care (VBC) models central to its response. The health plan's most recent gains in maternal health, senior care, and other areas are documented in new case studies. They are rooted in Healthfirst's ADVANCE health equity model which—combined with complex resource management, provider integration, and clinical leadership—has helped Healthfirst activate public health and equity as a care strategy, not a crisis response.
1. Results spanning conditions and populations
Healthfirst's new case studies feature better outcomes in five areas:
- Asthma – Fewer ER admissions for those with asthma, with AIRnyc
- Hypertension – A 30% improvement in six-month blood pressure control among South Asian Americans, with Project IMPACT, Community Heath Worker, and Million Hearts
- Senior care – Reduced hospital readmissions and higher likelihood of two or more PCP visits, with JASA care transitions program
- Maternal health – Higher rates of postpartum visit and outpatient gynecological care (11% and 7% respectively), with Mount Sinai
- HIV – Better overall health for those living with HIV/AIDS, with WholeYou
Healthfirst—a nonprofit integrated delivery network co-founded in 1993 with 15 hospitals—is delivering these results across its 1.7 million members in the New York City, Long Island, and surrounding areas enrolled in the company's Medicaid, Medicare Advantage, and individual and small group plans.
"These areas are compelling because public health and Healthfirst administrative and claims data showed clear issues," says Tom Wang, manager of research and evaluation, partnerships for medical outcomes with Healthfirst.
To this he adds one important callout: "Programs involving health equity are not targeted for quick wins." Wang noted the roughly three-year period to ensure careful program study, contracting, implementation, and evaluation.
The health plan's website features additional case studies of results targeted to additional senior care programs, disadvantaged community hot spots, and the right care for people struggling with mental health and substance abuse.
2. Adopting and personalizing proven models.
In the results above, notice the word "with." The power of "with" is central to Healthfirst's approach: find care models that are working, the community organizations that created them, then use plan and provider data to personalize them across both plan populations and individual neighborhoods.
In this way, Healthfirst's approach spans hyperlocal, state-level, and national models and partners.
"For senior care, we were advised to talk to JASA (Jewish Association Serving the Aging)," says Rashi Kumar, Healthfirst director of research and policy, partnerships for medical outcomes. "They already had a care transitions program and we implemented it using Healthfirst members and data. Another example is WholeYou, a Public Health Solutions program that Kumar reports was already evidence based.
These and other examples illustrate an unsung aspect of VBC: smart, complex resource orchestration.
3. Public health and equity as care strategy, not crisis response.
Using proven, partnership-based models suggests another aspect of resource management: an all-hands-on-deck approach to meeting the mission differently.
"The industry focused for a long time on reducing costs amongst so-called 'high utilizers of care', which is a stigmatizing term," says Kumar. "The focus on high cost, and reducing high cost, was the prevailing concept for a long time, and I believe it is adversarial to the true concept of population health."
To combat this, Healthfirst has embedded its health equity model, ADVANCE, throughout its operations. ADVANCE, as defined on the Healthfirst website, is named for its components and based on the belief that healthcare should be: Available, Data-Informed, Value-Driven, Accessible, Nurturing, Community-Based, and Evidence-Based.
Healthfirst is using its results and the ADVANCE model to call other stakeholders to action.
"Disparities will not be eliminated unless everyone is at the table," says Errol Pierre, Healthfirst SVP, state programs. "It's a team sport. And we are a health plan that does not take an adversarial role."
4. Analytics and clinical leadership.
Leadership is part of that team sport. Says Kumar: "We have proximity to public health leaders and researchers and the ability to look at Healthfirst data in concert with these experts. This includes clinical leaders at Healthfirst's member hospital, like Mount Sinai, and its own VP and executive medical director for partnerships and medical outcomes."
Healthfirst's analytics and clinical leadership is rooted in an alternate view of measuring equity.
"There is a big focus right now on being able to measure disparities by stratifying metrics, for example, cancer screening rates by race and ethnicities," says Kumar. "Some researchers are beginning to question whether this is solution-oriented enough … and are interested in measuring patient trust and developing an equity index. This is the next frontier: developing new methods to understand and even quantify equity."
5. From safety nets to safety networks.
Value-based has many meanings, depending on who you talk to. It is a contracting model, a care model, and a finance and reimbursement model. When VBC achieves its highest aims, it drives integration in a way that brings non-traditional, community providers to the table. The Healthfirst team says it believes that its approach is truly different, that it is a mission-, equity- and value-based glimpse into what the future of U.S. healthcare could look like.
Editor's note: This story was updated on December 27, 2021.
Laura Beerman is a contributing writer for HealthLeaders.
Healthfirst, a regional New York payer-provider health plan, is improving outcomes across conditions and populations through clinical partnership, resource management, and health equity.
Its ADVANCE health equity model is embedded operationally and a potential model for other stakeholders.
Plan leaders cite the plan's community- and value-based foundations as the reason for its success.