Lessons Learned from Value-Based Grant Program
By Stephanie Luster and Melissa Flores
Since 1996, Methodist Healthcare Ministries has invested more than $412 million in grants within our 74-county service-area. We believe that everyone deserves a fair opportunity to make the choices that lead to good health. Traditionally, our Community Investments department has made it a priority to promote access to clinical care in underserved communities, but we also recognize that root causes of poor health outcomes must be addressed if we are to achieve health equity and intervene effectively to break the cycle of intergenerational poverty.
With a national movement towards value-based payment models by the Centers for Medicare and Medicaid Services and other payors, in 2016 Methodist Healthcare Ministries’ Community Investments department developed a new grant program aligned with value-based concepts. These concepts included emphasizing quality of care rather than quantity of care and incentivizing health improvement through a flexible funding model.
This program, initially called Integrated Health Improvement, focused on improving specific health outcomes for a qualified panel of patients. A funding amount was allotted per patient on the panel, consisting of a base amount and incentive amounts. If the panel of patients reached the health outcome goal(s) by the end of the year, the funded partner received the incentive payment(s) for the goal(s) that was met. To the department’s knowledge, this program was one of the first, if not the first, value-based program from a regional nonprofit funder in South Texas, and it inspired another funder in our service area to support a similar program.
From 2017 to 2021, Methodist Healthcare Ministries’ value-based grant program served complex care patients in South Texas. During this time period, 15 of our Federally Qualified Health Center (FQHC) funded partners participated in this program.
Since the first grant year in 2017, the value-based program went through many adjustments, which were informed by funded partner feedback and outcome performance. One of the most notable changes to the program was the addition of prevention components after hearing from grantees that preventive measures were key to improving the health of the patient populations they served. The program was aptly renamed “Integrated Health Improvement & Prevention”.
Throughout the years, key program components remained similar—including patient eligibility, which specified that panel patients needed to be over 18 years of age, uninsured or underinsured, low-income, and patients must have at least two of the required comorbidities. Comorbidities included depression, pre-diabetes or diabetes, hypertension, and overweight or obesity. Health outcome goals also remained similar and reflected the specified comorbidities.
As we reflect on the program, we think there were many successes. Flexible funding allowed our partners to use their grant dollars in ways best suited to achieve program success. Some partners used this program to try new things for their health centers, like case management, patient dashboards, and program contracts/agreements with patients. During the program, partners increased their quality of care, including improving documentation, establishing and improving workflows, and strengthening follow-up with patients. These changes also helped grantees better prepare for reports and reviews from other funders. Their efforts helped to establish a consistent source of health care for patients, and patients exhibited improvement in their health. As we spent additional time with partners at their centers and communicated with them through email and phone to provide technical assistance and for audits, our relationships with partners strengthened.
There were also challenges with the program. Grantees, especially in rural areas, often have staff that wear multiple hats, making this complex program difficult to implement and manage. The program required ample staff time and training to develop and implement many processes, including finding or recruiting patients that met panel criteria, documenting their clinical data and financial information, and reporting back on patient level data four times a year. As partners built new processes, some encountered challenges with their electronic health record or billing systems. Once set-up and staff training were completed, another challenge that arose was patient attrition due to reasons such as patients moving, changing providers, or changing phone numbers. This made it difficult to fill the patient panel and keep patients engaged in care to help meet the challenging program metrics.
To help our partners with their challenges, we provided one-on-one technical assistance, held workshops, and sought their continuous feedback and suggestions through surveys and multiple check-ins. We modified and simplified the program design where we could. Modifications included explaining program elements more thoroughly and adjusting the program metrics to be more achievable. We simplified the reporting as the years went on, aiming to ask for only what was needed to determine panel eligibility, panel size, and metric attainment. We also connected partners with each other, to share ideas on electronic health record templates, program set-up, and eligibility documentation. If the challenges were too extensive for the partner—such as consistently not meeting their panel size or not meeting most goals—we transitioned them to another grant structure.
Many lessons were learned throughout the program, and in 2021 the program came to an end at Methodist Healthcare Ministries, as our organization changed its strategy around grant-making to be focused on achieving health equity and breaking the cycle of intergenerational poverty by addressing root causes and the Social Determinants of Health.
Our funded partner, Gateway Community Health Center, designed their value-based program, “Lado A Lado” or “Side by Side”, for their clinic locations in and around Laredo, Texas, and had great success with the value-based program. Gateway shared their experience with the program, and how it impacted their clinics and the lives of their patients in the video below.