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Stay ahead of healthcare industry news for FQHC and Health Center leaders with our monthly roundups. CareMessage curates the most important developments in healthcare technology, underserved patient care, value-based care, social determinants of health, and more to keep you informed in your role as a healthcare leader.
EHR company Practice Fusion has admitted to both soliciting and receiving kickbacks from a “major opioid company” and as a result, has agreed to pay $145 in criminal fines to federal and state governments.
The US Department of Justice found that Practice Fusion had received “sponsorship” payments from pharmaceutical companies in exchange for influence from the marketing team on the design of clinical decision support (CDS) system features — the goal being an increase in sales of the pharmaceutical company’s products.
The payment allowed the companies to impact the language used in alerts, potentially steering them away from meeting medical standards and jeopardizing the unbiased nature of the systems that physicians rely on to treat patients.
This article addresses the potential benefits and downsides of Walmart’s plans to host mental health clinics for self-paying patients. While $1 per minute and the chain’s nation-wide presence does likely promise increased access, especially in rural areas, it also raises the question of impact on FQHCs. If Walmart stepped into the same rural communities where many FQHCs already provide mental health services, what does it mean for centers who struggle with recruiting and staffing?
In the fourth article in a series dedicated to FQHCs, the National Law Review reviews guidance from HRSA and the practical implications of governance requirements. It covers topics including board composition, functions and responsibilities, and CEO approval.
JDSupra addresses the challenge of two-tier pricing models that provide lower reimbursements for 340B covered entities. The article includes an example of an FQHC and the rate cut it experienced from Humana, along with the subsequent suit for discriminatory reimbursement. As two-tier models become more common with payors and pharmacy benefit managers, safety net providers such as FQHCs will need to carefully assess billing requirements and the associated potential impact.
Serving the Underserved
In this article, Health Affairs covers governmental and community-oriented approaches to addressing a major social determinant of health —food insecurity. The journal delves into the seventh-largest food bank in the country, Mid-Ohio Foodbank and its role in bridging the gap between community and governmental food resources and healthcare provider teams.
Dr. Alexander Salerno heads up a family-run New Jersey practice that has served elderly and impoverished Medicare and Medicaid patients in the state for 50 years. Recently, UnitedHealthcare has terminated his contract, without explanation. Dr. Salerno discusses how this decision impacts patients’ feelings of disrespect, physician trust, and medication adherence.
This article from the University of California discusses the work and opinions of Dr. Samuel Washington (clinical fellow, urology) on the specialized treatment of prostate cancer for patients with less access to care. Dr. Washington highlights the fact that underserved patients have different outcomes than populations with better access to care and the importance of change on the personal level, for both doctors and patients.
FQHCs and VBC
Medical Economics discusses the importance of Medicare Annual Wellness visits in improving the health of patients, increasing revenues, and boosting quality scores in value-based reimbursement programs. While wellness visits are known to provide these benefits, there are still wide geographical variations, possibly due to physicians being more likely to promote them to patients in certain areas than others.
As pharmacy payment systems continue to shift from fee-for-service to value-based approaches expect to see increased awareness around social determinants of health, accompanied by a deeper understanding of the role providers play in improving outcomes and preventing hospitalizations.
Social Determinants of Health
A recent report from the Robert Wood Johnson Foundation and partners addresses the leading hardships faced by Americans. The study found that the top social determinants of health in 2019 were housing and food insecurity along with insights including:
22% of middle-income adults and 35% of lower-income adults report serious problems finding affordable housing.
24% of low-income adults struggle with their rent or housing payments.
30% of low-income adults face “serious problems” paying for food.
This report from the Annals of Family Medicine profiles the development of the Comprehensive Care Clinic at Southern Illinois University Center for Family Medicine.
The initiative recruited patients through multiple pathways, including probation and treatment courts and local shelters, as well as patients who were struggling with standard clinic care processes. It then applied a multidisciplinary team-based approach in which approximately 10 patients are seen in a half-day clinic. Team members were trained in patient-centered engagement techniques such as trauma-informed care and harm reduction. The report finds that this model can be replicated in other primary care settings with careful selection of team members.
Learn more about our worth with food banks in promoting diabetes prevention programs through text-based engagement here.