Considering Partnerships with Federally Qualified Health Centers

Uncertainty surrounding public healthcare exchanges and the impacts due to approaching changes in Medicaid eligibility has caused many health systems to reexamine how they deliver care. Health systems that are seeking to provide greater value to their communities should consider collaborating with federally qualified health centers (FQHCs), given the special legal and financial status of these organizations and their experience treating populations with complex needs.

As a result of their expertise in caring for vulnerable and underserved populations, FQHCs are particularly well-equipped to deliver or coordinate primary care, diagnostic, and preventive clinical services for newly insured Medicaid patients. FQHCs typically provide case management-enabling services such as outreach, transportation, and education about the availability and proper use of healthcare services. As such, an FQHC may be able to fill an important link in a system’s continuum of care.

Unlike most providers, FQHCs have safe harbor status from the anti-kickback statute, provided that arrangements are not conditioned upon referrals to the supplier. Appropriate arrangements result in savings of federal grant funds or increased revenues to the FQHC, do not limit patient choice, protect the independent medical judgment of providers, and can reasonably be expected to maintain or increase service availability and quality.

Building relationships with FQHCs can enable health systems to improve the value, availability, and appropriateness of care for all members of the community. As reimbursement moves toward increasingly risk- and value-based models, FQHCs also bring unique expertise within the continuum of care in delivering care to patients who are at higher risk of undergoing avoidable care due to socioeconomic and clinical factors. Successful partnerships between health systems and FQHCs focus on collaborative strategies of mutual and community benefit. Overarching health system strategies leading to benefits for all parties may include:

  • Partnering with FQHCs to manage the health of Medicaid, uninsured, and newly insured exchange populations
  • Aligning with FQHCs to increase access to primary care services within the community
  • Integrating clinical management functions to improve the coordination of care

With increasing pressure to operate under performance based arrangements for increasing Medicaid and public exchange oriented products, health systems may wish to explore opportunities to include FQHCs in their delivery system.

This post was initially featured, April 22, 2013, on the hfm Healthcare Finance Blog.

This entry was posted in Affordable Care Act, Legislative & Regulatory Issues, Patient-Centered Care and tagged , , , by Charlie Brown. Bookmark the permalink.

About Charlie Brown

Charlie works in ECG’s Managed Care practice, where he focuses on strategic health plan contracting, negotiation, and revenue recovery. With more than 18 years of healthcare management and consulting experience, he has been successful in improving the bottom line of clients’ financial and operational performance. He has assisted clients in complying with the intricacies of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and Sarbanes-Oxley §404 requirements. As a Director at a national consulting firm, he focused on managed care contracting, operations, and revenue recovery. His expertise was developed while he was Director of Managed Care/Vice President of Practice Operations at Founders Health Care (Allegheny Integrated Health Group) and an Operations Manager/Medical Center Administrator at FHP Inc. Charlie holds a master of business administration degree from The University of Utah and a bachelor of arts degree in biology from the University of Colorado.

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s