Quality Measures

Implications of Value-Based Care for FQHCs

With a renewed nationwide focus on patient-centered care, many states and payers are starting to move away from a traditional fee-for-service model in favor of more value-based care reimbursements. The shift will no doubt have an impact on every healthcare organization, but FQHCs and other safety net community clinics that provide services to underserved populations should, in particular, expect significant changes.

The Current State of FQHCs

A recent survey found that more than half (56 percent) of FQHCs rate financial stability to be moderately difficult or extremely challenging. This could be  due to the fact that they are reimbursed on a fee-for-service model, which rewards health centers based on appointment volume. For FQHCs, whose patients often have trouble getting to appointments due to lack of transportation, long work days or poor health literacy, volume can be difficult to maintain. To ensure financial stability under this model, FQHC staff must spend significant time simply ensuring that appointments are filled, leaving little bandwidth to help fill gaps in care or ensure better outcomes.

The same survey demonstrated that reimbursement models aren’t the only factors impacting FQHC revenue cycles. Nearly half of the respondents indicated that they face direct competition from another FQHC, and 61 percent of FQHC leaders expect competition to rise in the next year. Many urban and rural FQHCs find themselves up against better funded organizations—including hospitals and urgent care centers— that are willing to treat uninsured patients covered under Medicare expansion programs. For these FQHCs, a shift from traditional fee-for-service to a value-based care model could be just the change they need.

The Challenges and Opportunities Ahead

While the shift from fee-for-service to value-based care is a light at the end of the tunnel, the transition will take time. However, many of the foreseeable challenges can be addressed while providing great opportunities for FQHCs to make progress toward reducing costs and improving care:

1. Employee Retention

In the short-term, efforts to transform care delivery can create added burden on FQHC staff, who already experience high rates of burnout.  But in the long-term, the transformation to value-based care could ultimately mean a happier workforce.

According to a new study published by Health Affairs, efforts to transition to patient-centered care at community health centers contributed to workplace dissatisfaction and burnout. Researchers found that clinicians and support staff at community health centers working to achieve medical home recognition reported over a one-year period that their professional satisfaction declined by 10% and feelings of burnout increased by 8%.

However, as the adoption of value-based care models increases, the rate of employee burnout is likely to drop. As organizations implement a more patient-centered approach to care their employees will reap the benefits of a more efficient system and better patient-provider interactions. Staff will be able to refocus their efforts on achieving what was likely their intended mission in entering the healthcare field: caring for patients. Improved employee retention leads to high-quality staff and reduced training costs. Plus, studies show that satisfied employees lead to more satisfied patients.

2. Data and Technology

One of the most overlooked challenges to switching payment models is the amount of data required to successfully sustain value-based care. Before making the shift, FQHCs will have to integrate more effective technology capable of managing the increase of patient information sharing across providers. However, by increasing the level of transparency between providers, more intelligent decisions can be made about effective treatments and improved quality of care. While new data systems will likely require additional hires, the promise of better outcomes overall make the move inherently beneficial for FQHCs.

3. Cost

Changing reimbursement models will undoubtedly come with associated costs for FQHCs. Investment must be made in infrastructure, technology, leadership and staff in order to support the new model of care. But, as researches from Portland State University found, spending money in the short term can often lead to greater savings in the long term. In fact, they found that for every $1 increase in primary care expenditures related to patient-centered care, $13 was saved in other services such as specialty care, emergency department and inpatient care. The new payment model saved organizations in Oregon $240 million over three years. By partnering with payer organizations to reduce costs, FQHCs will reap the rewards of value-based care incentives, rather than having to consistently ramp up volume to stay financially viable.

4. New Partnerships

The current fee-for-service payment model has done very little for the unification of healthcare by keeping services unbundled. The introduction of value-based care aims to challenge that, by bringing the attention back to the patient and encouraging new partnerships focused on better outcomes. To be successful, FQHCs will need to carefully consider partnerships with a variety of organizations including hospitals, payers, technology providers, and community organizations such as social services agencies, food banks, homeless shelters, mental health agencies and more. If done well, these partnerships can help providers improve the overall health of their patients and achieve value-based goals.

The state-to-state implementation of a value-based care model could be a game changer for FQHCs that struggle to stay out of the red. By focusing on treating underserved populations, minimizing readmissions, and improving preventative care measures, organizations could see a significant increase in reimbursement payments.

To learn more about how a smart patient engagement strategy can help ease the transition to value-based care, use the form below to connect with the CareMessage team.

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