Skip to main content
Sister Publication Links
  • ESG: THE NEW IMPERATIVE
Subscribe
  • My Account
  • Login
  • Subscribe
  • News
    • Current News
    • COVID-19
    • Providers
    • Insurance
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • Transformation
    • People
    • Regional News
    • Digital Edition (Web Version)
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • Midwest
    • Northeast
    • South
    • West
  • Digital Health
  • Insights
    • ACA 10 Years After
    • Best Practices
    • Special Reports
    • Innovations
  • Data/Lists
    • Rankings/Lists
    • Interactive Databases
    • Data Points
  • Op-Ed
    • Bold Moves
    • Breaking Bias
    • Commentaries
    • Letters
    • Vital Signs Blog
    • From the Editor
  • Awards
    • Nominate/Eligibility
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • Best Places to Work in Healthcare
    • Excellence in Governance
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top 25 Emerging Leaders
    • Top 25 Innovators
    • Diversity in Healthcare
    • Women in Healthcare
    • - Luminaries
    • - Top 25 Diversity Leaders
    • - Leaders to Watch
    • - Luminaries
    • - Top 25 Women Leaders
    • - Women to Watch
  • Events
    • Conferences
    • Galas
    • Virtual Briefings
    • Webinars
    • Custom Media Event: ESG Summit
    • Transformation Summit
    • Women Leaders in Healthcare Conference
    • Social Determinants of Health Symposium
    • Leadership Symposium
    • Health Care Hall of Fame Gala
    • Top 25 Women Leaders Gala
    • Best Places to Work Awards Gala
    • Top 25 Diversity Leaders Gala
    • - Hospital of the Future
    • - Value Based Care
    • - Supply Chain Revenue Cycle
    • - Hospital at Home
    • - Workplace of the Future
    • - Strategic Marketing
    • - Virtual Health
  • Listen
    • Podcast - Next Up
    • Podcast - Beyond the Byline
    • Sponsored Podcast - Healthcare Insider
    • Video Series - The Check Up
    • Sponsored Video Series - One on One
  • MORE +
    • Advertise
    • Media Kit
    • Newsletters
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
Breadcrumb
  1. Home
  2. Opinion & Editorial
October 23, 2020 03:14 PM

Throw health centers a lifeline by replacing outdated payment model

Hope Glassberg
  • Tweet
  • Share
  • Share
  • Email
  • More
    Reprints Print
    Hope Glassberg is chief strategy officer at New York-based Sun River Health, formerly known as Hudson River Health Care.

    At this crucial moment before a second wave of COVID-19 crests and crashes, policymakers should confront a significant payment problem brewing within our primary-care safety net that, if unaddressed, threatens care for millions of Americans.

    Though much of healthcare has made progress with value-based payment models, most federally qualified health centers (FQHCs) remain tethered to an outdated, visit-based payment structure. Without change, many centers will not stay afloat for long.

    In her Sept. 8 opinion piece for Modern Healthcare, "Agility is the key to success for community providers—and for the future of value-driven care," Tara Hoffman of California-based Borrego Health outlines the importance of FQHC services, particularly in lower-income and rural communities, and the steps necessary to adapt in a post-COVID reality. To support those concepts, policymakers must advance policies that enable FQHCs to re-invest and re-invent.

    It is worth understanding where FQHCs have come from to reveal the path to dry land. Health centers rose to prominence during the War on Poverty era, when President Lyndon Johnson dedicated the first federal funding for community health centers under the Economic Opportunity Act. FQHCs are meant to solve a market problem: using federal resources and protections, health centers are established in "medically underserved areas" and provide primary and preventive healthcare services to all individuals, regardless of ability to pay.

    Today over 1,400 health centers serve 29 million people across the U.S. Health centers predominantly serve individuals on Medicaid who identify as belonging to racial and ethnic minority groups. Emerging evidence suggests that individuals of racial and ethnic minority groups –consistent with the primary demographic of health centers—are disproportionately impacted by Covid-19.

    In other words, a strong primary-care safety net, embodied in FQHCs across the country, is crucial for fending off the worst of COVID's second wave. Unfortunately, the FQHC payment model present in most states today is alarmingly inflexible.

    In 2001, Congress established the current prospective payment system model that pays FQHCs a single per-visit rate for each qualifying patient encounter. As the pandemic hit, the health centers, like every other healthcare provider, switched seemingly overnight to virtual modes of care. Many facilities were then forced into labyrinthine negotiations with payers and states to fight for parity between in-person and virtual visit reimbursement, often on different fronts across agencies overseeing health, mental health, and substance use disorder services.

    These conversations for FQHC leaders, all while trying to reach high-risk patients, manage furloughs, and dispel misinformation were a distraction factor few could afford to take on. Today many health centers teeter on the brink of financial ruin.

    In a world with more universal capitated models, FQHCs could have simply shifted between in-person and virtual care, without the complicated back and forth with payers or states. Importantly, the key value of an FQHC alternative payment model is flexibility rather than reducing excessive utilization and costs within the health center. If anything, FQHCs, which typically operate on razor-thin margins, are very cost-efficient. While a number of states have pursued FQHC APMs, many of these models are limited pay-for-performance structures or simply rework portions of the existing PPS.

    In order to financially sustain our primary-care safety net, policymakers must create expedited pathways for FQHC APMs that not only support hybrid in-person and virtual services, but also seize the moment to adequately invest in primary care, tying health center capitations to meaningful percentages of total cost of care.

    In the first wave of COVID-19, FQHCs rose to the challenge, testing more than 200,000 patients, over half of whom belonged to racial and ethnic minority groups. Without immediate steps to reimagine the payment model, these health centers—and their never-more-relevant mission to address healthcare inequities—may be lost at sea, another casualty of the pandemic.

    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    Vaccines
    Pfizer to offer low-cost medicines, vaccines to poor nations
    healthcare costs_i.jpg
    AMA: Insurers not sticking to prior authorizations deal from 2018
    Sponsored Content
    Get Newsletters

    Sign up for enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today
    MH Magazine Cover

    MH magazine offers content that sheds light on healthcare leaders’ complex choices and touch points—from strategy, governance, leadership development and finance to operations, clinical care, and marketing.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS

    Our Mission

    Modern Healthcare empowers industry leaders to succeed by providing unbiased reporting of the news, insights, analysis and data.

    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Advertise with Us
    • Ad Choices Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    • Privacy Request
    Modern Healthcare
    Copyright © 1996-2022. Crain Communications, Inc. All Rights Reserved.
    • News
      • Current News
      • COVID-19
      • Providers
      • Insurance
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • Transformation
        • Patients
        • Operations
        • Care Delivery
        • Payment
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition (Web Version)
    • Digital Health
    • Insights
      • ACA 10 Years After
      • Best Practices
      • Special Reports
      • Innovations
    • Data/Lists
      • Rankings/Lists
      • Interactive Databases
      • Data Points
    • Op-Ed
      • Bold Moves
      • Breaking Bias
      • Commentaries
      • Letters
      • Vital Signs Blog
      • From the Editor
    • Awards
      • Nominate/Eligibility
      • 100 Most Influential People
      • 50 Most Influential Clinical Executives
      • Best Places to Work in Healthcare
      • Excellence in Governance
      • Health Care Hall of Fame
      • Healthcare Marketing Impact Awards
      • Top 25 Emerging Leaders
      • Top 25 Innovators
      • Diversity in Healthcare
        • - Luminaries
        • - Top 25 Diversity Leaders
        • - Leaders to Watch
      • Women in Healthcare
        • - Luminaries
        • - Top 25 Women Leaders
        • - Women to Watch
    • Events
      • Conferences
        • Transformation Summit
        • Women Leaders in Healthcare Conference
        • Social Determinants of Health Symposium
        • Leadership Symposium
      • Galas
        • Health Care Hall of Fame Gala
        • Top 25 Women Leaders Gala
        • Best Places to Work Awards Gala
        • Top 25 Diversity Leaders Gala
      • Virtual Briefings
        • - Hospital of the Future
        • - Value Based Care
        • - Supply Chain Revenue Cycle
        • - Hospital at Home
        • - Workplace of the Future
        • - Strategic Marketing
        • - Virtual Health
      • Webinars
      • Custom Media Event: ESG Summit
    • Listen
      • Podcast - Next Up
      • Podcast - Beyond the Byline
      • Sponsored Podcast - Healthcare Insider
      • Video Series - The Check Up
      • Sponsored Video Series - One on One
    • MORE +
      • Advertise
      • Media Kit
      • Newsletters
      • Jobs
      • People on the Move
      • Reprints & Licensing