FQHCs, and MCOs Moving to VBC Together

The time is now for Community Health Centers (CHCs), interchangeably called Federally Qualified Health Centers (FQHCs), FQHCs and MCOs to develop, implement and model evidence based solutions that close longstanding health equity and care gaps. FQHCs are community-based healthcare providers that serve underserved and vulnerable populations, including low-income individuals and families, homeless individuals, and rural residents. Value-based care is a healthcare delivery model that seeks to provide high-quality care at a lower cost by focusing on patient outcomes and preventive care, rather than the volume of services provided.

 

FQHC Difficulty

The difficulty facing many FQHCs is that this transition is delicate due to low Medicaid reimbursements which are often tied to the volume of services provided, and value-based care models focus on outcomes and preventive care, rather than the number of services provided. FQHCs are vulnerable in that while dependent upon volume, their budgets are heavily balanced by grants, donations, and other restricted funds. This prevents the right kind and amount of investment needed to focus on preventive care, provider relationship building and retention as well as outreach efforts, specifically efforts to close addressable social determinants, unmet needs.

As a result, FQHCs must carefully manage this transition to ensure that they can balance their budgets while still providing high-quality care to their patients. This will involve implementing new care coordination strategies, investing in staff training and development, and leveraging technology and data to improve the efficiency of care delivery.

Managed Care Organizations

Managed care organizations must invest in FQHCs to present opportunities to improve the quality and efficiency of care provided to underserved populations. By focusing on outcomes and preventive care, CHCs can improve patient outcomes and reduce healthcare costs, which can benefit both patients and healthcare providers. To provide critical skills to manage chronic conditions and prevent falls, FQHCs may offer health education programs and wellness initiatives to promote healthy behaviors and lifestyle choices. ‘

They may also provide screening and assessment services to identify and manage chronic conditions, such as diabetes, hypertension, and heart disease. In addition, FQHCs may collaborate with community-based organizations, social service agencies, and other healthcare providers to develop comprehensive care networks for older adults. These networks can provide a range of services and support, including transportation, social activities, and home health services, to help older adults maintain their health and independence.

Overall, increasing the number of older adults served by FQHCs and providing them with critical skills to manage chronic conditions and prevent falls is an important step in improving the health and well-being of this population. By investing in specialized care, health education, and care coordination, FQHCs can better meet the needs of older adults and support them in maintaining their health and independence.

 

Challenges and Opportunities

Here are some of the challenges and opportunities that value-based care presents for FQHCs:

Challenges:

• Financial risk: Value-based care models shift financial risk to healthcare providers, which can be challenging for FQHCs with limited financial resources.
• Data infrastructure: FQHCs may lack the infrastructure and resources necessary to collect and analyze the data needed to measure patient outcomes and quality of care.
• Staffing and training: FQHCs may need to invest in additional staffing and training to implement value-based care models, which can be difficult in resource-constrained environments.
• Patient engagement: Value-based care models require patient engagement and participation, which can be challenging for underserved populations with limited access to healthcare.

 

Opportunities:

• Improved patient outcomes: Value-based care models incentivize healthcare providers to focus on patient outcomes and preventive care, which can result in improved health outcomes for underserved populations.
• Financial incentives: Value-based care models offer financial incentives to healthcare providers who improve patient outcomes and reduce healthcare costs, which can benefit FQHCs with limited financial resources.
• Care coordination: Value-based care models promote care coordination and collaboration among healthcare providers, which can improve the quality and efficiency of care for underserved populations.
• Quality improvement: Value-based care models encourage continuous quality improvement, which can help FQHCs identify areas for improvement and enhance the quality of care provided to underserved populations.

 

Value-based care presents both challenges and opportunities for FQHCs. By focusing on patient outcomes, promoting care coordination, and incentivizing quality improvement, value-based care models have the potential to improve the quality and efficiency of care provided to underserved populations, while also offering financial incentives to healthcare providers. However, implementing value-based care models can be challenging for FQHCs with limited financial resources and infrastructure, requiring careful planning and investment in staff and resources.

FQHCs are well-positioned to participate in these programs and earn incremental revenue, as they often provide underserved and vulnerable populations and have experience delivering high-quality, cost-effective care. By leveraging their expertise and experience, FQHCs can work with health plans to identify areas for improvement and develop strategies to improve patient outcomes and reduce healthcare costs.

In addition to earning incremental revenue, participation in quality improvement programs and VBP models can also help FQHCs strengthen their relationships with health plan partners and demonstrate their commitment to delivering high-quality, patient-centered care. By working collaboratively with health plans and other healthcare providers, FQHCs can help to improve the overall quality and efficiency of healthcare delivery and improve the health outcomes of the populations they serve.

Joseph F. West, ScD

EVP, Business Innovations and Solutions