Fidelis Care tackles SDOH in upstate New York using a referral platform

Fidelis Care’s new partnership with Healthy Alliance Independent Practice Association and Innovative Health Alliance of New York aims to address social determinants of health among its Upstate New York Medicaid population.


Fidelis Care’s new partnership with Healthy Alliance Independent Practice Association and Innovative Health Alliance of New York aims to address social determinants of health among its Upstate New York Medicaid population.

The new partnership, which will provide funding and coordination of services, reflects a larger movement to improve population health.

Under the new initiative, which will begin October 1, Fidelis aims to bring together medical providers and community-based organizations to address SDOH, which includes factors such as housing, nutrition and employment. Avoiding hospital visits and increasing preventive care visits will be the top goals.

Fidelis will target members with at least one chronic health condition who haven’t visited their healthcare provider in more than six months. The new initiative will help to ensure that Fidelis Care’s Medicaid members have even greater access to affordable, quality health coverage, says David Thomas, president and CEO of Fidelis Care.

IHANY will connect Fidelis members to the Healthy Alliance network of community-based organizations, which can provide social, behavioral and medical care through Healthy Together, a referral platform powered by Unite Us.

Aligning with community-based organizations is often the first line of defense in providing for the underlying needs that lead to poor health, says IHANY Board President Paul Barbarotto, DO, who practices at Capital Region Family Health Care, a part of St. Peter's Health Partners Medical Associates. “A person’s health can now be recognized as much more than the medical care individuals seek from doctors and hospitals.”

Formed in 2014, IHANY, which strongly supports a holistic mind-body-spirt approach to care, is the only network of providers certified by New York state and Medicare as an accountable care organization in the Capital Region.


“Research clearly shows us that the health of people is largely influenced by factors outside the walls of where they get medical care," says IHANY CEO Leslie Barden, "The United States spends significantly less than other developed nations in addressing social determinants of health, including safe housing, adequate nutrition and psycho-social supports. We believe this is a game changer in improving health for all the people we jointly serve.”

Healthy Alliance IPA is the first IPA in the nation entirely devoted to addressing SDOH, the group says. The IPA serves as a central point of contact to connect medical providers, community-based organizations, accountable care organizations such as IHANY, and managed care organizations like Fidelis Care. By serving as a central point of contact between these diverse organizations, the independent practice association can ensure each of these entities work together to maximize a person’s health, Healthy Alliance says.

According to Jacob Reider, MD, CEO of Alliance for Better Health, the independent practice association’s success is a byproduct of the partnerships it has built in New York’s Capital Region. “Together, we can improve our community members’ health by addressing social needs before they evolve into medical problems.”

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