Connectivity and care coordination help FQHCs survive a strained environment

Federally Qualified Health Centers (FQHCs) and other community health centers (CHC) deliver primary care to the most clinically underserved and socioeconomically challenged communities in the country – the exact communities that are now bracing to feel the devastating impacts of up to $1 trillion in Medicaid cuts over the next decade.

FQHCs rely on this funding (alongside grants, donations, and a smattering of Medicare reimbursement), to perform vital work for high-risk, highly complex populations.  

Their success is easy to quantify.  Despite serving more than 10% of US residents, community health centers account for a mere 1% of total healthcare spending, which represents one of the best value-for-money deals in the industry. 

They achieve these remarkable results with a strong mission-driven philosophy – and the support of technology partners that provide a reliable digital foundation for their patient-centered work. 

At CHP Berkshires, a multi-site FQHC serving remote areas of Western Massachusetts, one of those technology partners is athenahealth: a well-known name in the CHC environment. Serving around 20% of all CHCs, athenahealth recently announced a redesigned EHR platform for its community health customers that focuses on enabling connectivity and care coordination for whole-person care.  

“As an FQHC, we know about tightening our belt when we need to,” said Jesse Suphan, director of revenue cycle at CHP Berkshires, to Digital Health Insights. “But these days, there’s not a lot of the belt left to tighten.” 

“To compensate for staff shortages and rising demand, we have to be on top of our data, which is the key to succeeding with initiatives like value-based care that can provide some extra financial benefits.” 

Leveraging value-based care to improve service and sustainability

Value-based care models, such as accountable care organizations (ACOs), have long been an attractive option for FQHCs. In 2022, close to a quarter (24.3%) of active ACOs had at least one FQHC participant, helping to improve quality performance without significantly increasing costs.  

For FQHCs, these ACO models offer a blueprint to structure care coordination and quality reporting, as well as additional revenue streams to support sustainability in a precarious economic environment. 

“We’ve been part of a Medicaid ACO for the last few years, and we’re starting to become more successful,” said Suphan. “We also started with a Medicare ACO at the beginning of this year. We’ve been able to take a lot of the learnings from the Medicaid space and apply them to the Medicare contract, such as accurately capturing diagnoses, identifying gaps in quality measures, and immediately recalling or connecting with patients who haven’t met those measures yet.” 

Accurate and appropriate risk adjustment is crucial for setting fair financial baselines for incentives, and FQHCs need the right analytics capabilities to identify, stratify, and report on the health status of their populations. 

“That means we need to identify our higher-cost, higher-complexity populations and offer them preventive treatment,” Suphan explained. “We’ve been very successful using our data to identify those folks, recall them for care when necessary, and stay in contact with them through care management programming. We’re starting up with remote patient monitoring soon, as well, so we can stay connected with our patients in more remote or rural environments.” 

FQHCs like CHP Berkshires offer a wide variety of primary care services to people in these settings, including dental care, OB-GYN services, behavioral healthcare, and nutrition counseling.  

“Combining all those disparate data sources with our medical EHR data has always been a nightmare due to the lack of standardization,” noted Suphan. “Now, we have all those patients in the same database so we don’t have to spend a month or two trying to get them into the same place for reporting purposes. It’s so incredibly helpful to have that centralized place for dental, OB-GYN, family practice, and pediatrics – for us and for our patients to access their own records – so we can share information across segments. The improvement in care coordination and care management has been so impactful.” 

A collaborative approach to training and education

Training on new technologies is a challenge for all providers, including FQHCs. Finding creative, impactful strategies for staff education isn’t always easy, but it’s an essential component of success.  

“There are always people who are used to doing things with sticky notes and binders, and it can still be difficult to get them to change how they operate,” he acknowledged. “We have an internal training hub, which is the first thing you see when you open your browser, and we have champions and super users in every department that will engage with their teams and share resources in a really targeted way to get people excited about the possibilities.” 

“We’re the most successful when we engage every level of staff in the process – not just the learning and training, but the actual roll-out and ongoing monitoring so we can see what’s working and what needs to be adjusted. Communication is key, both with our staff and with our technology partner so we can make continuous improvements and ensure we’re leveraging the technology to its fullest potential.” 

Finding a way forward through an uncertain future

Upcoming Medicaid cuts are poised to become a big problem for FQHCs across the country, many of which will be losing a major source of their income as hundreds of thousands of patients are kicked off their insurance coverage. 

To withstand the coming storm, FQHCs will need to squeeze every bit of efficiency out of their processes, assisted strongly by digital health tools, and find new pathways forward in a difficult new era for community care. 

For Suphan, working closely with other providers in the community will be the key to maintaining a seamless network of support for underserved populations during these challenging times ahead. 

“Partnership is everything in healthcare, and FQHCs make excellent partners for the community,” he stressed. “A lot of private practices and health systems aren’t aware of the full scope of services we offer, including referrals to socioeconomic services and help with navigating the insurance environment.”   

“We have food pantries, gas cards, transportation services, legal advice – we’ve got so many of those services that a lot of primary care offices don’t have the bandwidth to provide. They can work with us on those additional supports so that we can prevent individuals from slipping through the cracks.” 

On the technology side, Suphan is eager to see health IT companies continue to lean into interoperability, connectivity, and analytics tools. 

“There is extraordinary value in these capabilities for community care providers, especially those participating in value-based care activities,” he concluded. “When we can get all the information we need to make more informed decisions, then we can make the best possible use of our increasingly limited resources to fulfill our shared mission and keep our communities healthier.” 

Jennifer Bresnick is a journalist and freelance content creator with a decade of experience in the health IT industry.  Her work has focused on leveraging innovative technology tools to create value, improve health equity, and achieve the promises of the learning health system.  She can be reached at [email protected].