Federally qualified health centers, long accustomed to getting by on volume-based public insurance reimbursements and government support, are experimenting with value-based care. Modernizing may be their best path to sustainable, high-quality care but community health centers can’t simply copy the models other providers have implemented.
Community of Hope, which operates three federally qualified health centers in Washington, wants to build out its maternal and child health capabilities. That would entail hiring lactation consultants and care coordinators, spending on patient transportation and more. But the plans rely on grant funding, which comes and goes. And that’s not a long-term solution, said President and CEO Kelly McShane.
“How do we get out of this—just grants that go up and down?” she asked.
Community health centers across the country are trying to solve similar problems by wading into value-based payment, partly because it offers more versatility in how funds are spent.
Moreover, federal law requires alternative payment programs to reimburse these clinics at least what they receive from government payers, which can conflict with risk-based models. Under some of these systems, providers that take on risk must return money when they fail to hit cost or utilization metrics. For community health centers, that could mean getting less than their minimum reimbursements, which isn’t allowed.
Government health programs and private insurance companies typically pay community health centers based on the volume of care they provide, and federal grants partially compensate them for treating uninsured patients.
States can also implement voluntary alternative payment models through Medicaid, and several have.
These clinics care for patients regardless of their ability to pay. Medicaid is the largest payer in most states, according to the Kaiser Family Foundation. Value-based payment allows more flexibility in care delivery, which can benefit community health centers, said Jeremy Crandall, director of federal and state policy for the National Association of Community Health Centers.
The flexibility that comes with alternative payment models also can aid health centers in carrying out their essential mission, Crandall said. These approaches enable the facilities to devote more attention to social determinants of health and data-driven care than under fee-for-service models.
Mosaic Medical, which operates more than a dozen community health centers in central Oregon, runs a mobile clinic primarily aimed at the homeless population. Value-based payment makes such initiatives more achievable, said Megan Haase, CEO of the Bend-based provider.