Healthy Alliance is one of the few companies that has adapted the medical independent practice association model to meet social needs.
As payers and other stakeholders attempt to address the social determinants of health (SDOH), one question, with many answers, remains: how?
Beyond identifying and prioritizing need, allocating investments, and demonstrating ROI, there is the challenge of creating an entirely new infrastructure of contracting, "claims," and reimbursement that involves community-based organizations (CBOs).
In New York, Healthy Alliance is leading these innovations. It has created one of the first social independent practice associations (social IPA) in the nation, taking the traditional IPA model—i.e., allowing independent providers to share resources and gain collective contracting power with payers—and applying it to CBOs instead of medical providers.
HealthLeaders interviewed Healthy Alliance leadership to discuss how social IPAs support different stakeholders, how they contract with payers, the steps required to become a social IPA, and why Healthy Alliance believes their model is better for payers.
Creating a social IPA
"We created the entity, were awarded the IPA designation in late 2018 [from New York state government agencies], and built it from there," says Erica Coletti, CEO of Healthy Alliance.
"We were one of the first," she notes, adding: "Other IPAs that have emerged since are often focused on subpopulations such as individuals with mental health or intellectual and developmental disabilities. We want to work with those IPAs and more broadly, help everyone with essential needs."
Coletti states that the organization's "referral network and IPA convene and collaborate with community partners—from regional hospitals to local food pantries—to address social needs before they evolve into serious and costly medical problems."
The social IPA is one of three affiliates of Healthy Alliance, which connects the underserved to a growing network of organizations—big and small—that provide services that are essential for a healthy life. Healthy Alliance partners with more than 580 organizations across 22 New York counties. The goal is to ensure that every New Yorker has consistent access to the resources they need to enjoy the same opportunity to be healthy.
Coletti adds that "the mission/business model is the same throughout—laying the foundation for Healthy Alliance to improve health and empower the underserved."
Contracting with payers
Independently or as a hospital subcontractor, Healthy Alliance can deliver its social service provider network to New York payers in a streamlined way.
"The IPA was formed so that we can enter contracts with Managed Care Organizations [MCOs] on behalf of our network of social care providers," said Coletti.
Contracting is just the starting point.
Michele Kelly, the organization's CFO/CAO, notes: "We're able to provide backbone infrastructure and analysis to work with payers, CBOs, and other entities on individual costs and services—to evolve a new model that starts to project volume."
Coletti adds that, for SDOH: "Claims don't exist in social services today and we need to work with CBOs to determine how to charge for the services, like establishing a case rate, fee schedule, and how they can cover their costs."
"Health plans have enough to do"
"Health plans are already forming and starting to contract with social care provider networks," says Kristen Scholl, VP of strategic partnerships for Healthy Alliance.
She notes that this is required for the Medicaid value-based payment (VBP) program in New York and that national players like Kaiser Permanente and Aetna, a CVS Health company, are creating their own closed-loop referral networks. Scholl believes, however, that social IPAs convened on behalf of payers, CBOs, providers, and other stakeholders is the better way.
"Health plans have enough to do," adds Scholl. "They're trying to meet so many state and federal regulatory requirements, Medicare Star Ratings, Medicaid quality NCQA/HEDIS—so many requirements and standards"
"You want your membership to be healthy in part to watch your bottom line," says Scholl. "It involves reducing unnecessary hospitalizations and managing total cost of care to improve the health of the people you're covering with downstream benefits."
A better model
Healthy Alliance believes its model allows health plans to move beyond a philanthropic approach to SDOH to one that unifies and streamlines.
It is for these reasons that Healthy Alliance's social IPA model is intentionally payer and population agnostic. Scholl believes this is the direction payers should go instead of creating their own social provider networks.
"MCOs are in an exciting position to develop social care strategy that leverages referrals, data, and resources in a meaningful way," adds Scholl. "This makes a difference for CBOs, who often get stuck in the middle between payers and members."
Kelly adds: "Health plans don't have the resources to provide CBO infrastructure either. They're not set up for that. Healthy Alliance provides monthly, high-touch support."
Kelly also states: "CBOs are being asked to move into space they've never been involved in. Healthy Alliance is helping build the knowledge and infrastructure related to billing, data, and analysis. Why have them take the time to build this on their own?"
Government approval
Becoming a social IPA requires state government approval. In New York, it is the same process by which medical IPAs are authorized: first, by the Department of Health; next, the Department of Financial Services; and finally, the Department of Education. For example, the Department of Health requires that:
- The IPA delivers services following the contracts and compensation agreements it has with MCOs.
- The IPA can be a business, limited liability (LLC), or non-profit corporation that must identify its leadership, members, and their affiliations (e.g., health plans, healthcare companies).
- The states in which the principals (if the IPA is a corporation or LLC) may be "licensed or approved to operate an HMO, IPA, PPO, or to provide health services or insurance."
Unique and shared benefits
Healthy Alliance's stakeholders span MCOs, clinical providers and health systems, and community organizations—the latter ranging from CBOs to schools and government agencies. Scholl notes that Healthy Alliance's core advantages are common to multiple stakeholders.
"In some ways, the social IPA doesn't need to be framed differently for hospitals or payers since the purpose is to contract with HMOs," she says, adding: "Hospitals will have VBP agreements with MCOs that have SDOH components so the IPA can provide social care services as a subcontractor to the hospital VBP contract."
Benefits common to payers, providers, and CBOs include:
- Mutual accountability and better alignment
- A platform to identify need, track referrals, and outcomes
- Improved outcomes and better care delivered at a lower cost
- More sustainable, VBP SDOH investments with demonstrable ROI
- Streamlined approach that frees each stakeholder to focus on what they do best
Kelly adds: "The goal is to bring up the whole network together."
“Other IPAs that have emerged since are often focused on subpopulations such as individuals with mental health or intellectual and developmental disabilities. We want to work with those IPAs and more broadly, help everyone with essential needs.”
Erica Coletti, CEO, Healthy Alliance
Laura Beerman is a contributing writer for HealthLeaders.
KEY TAKEAWAYS
New York-based Healthy Alliance was one of the first social IPAs in the U.S.
Payers, providers, community-based organizations, and other stakeholders can use its model to address social needs.
The organization believes this approach is better than homegrown solutions, even among national payers, given the need to unify, streamline, and deliver on SDOH infrastructure.