Redesigning Value-Based Care Models to Favor FQHCs

Cesar Herrera

By Cesar Herrera, CEO and Co-Founder of Yuvo

For many communities, Federally Qualified Health Centers (FQHCs) are one of the only options for affordable, accessible care. With few primary care providers accepting Medicaid beneficiaries or uninsured individuals, FQHCs and community health centers act as a critical safety net for individuals who often have complex clinical and socioeconomic needs.

Throughout my career in health policy and population health management, I’ve experienced the hard truth that our current financial and regulatory landscape isn’t designed to prioritize the success of this safety net. Most organizations that choose to pursue the FQHC designation don’t do it because they think it’s a profit-driven business model. They do it because they are committed to addressing the unmet needs of vulnerable, underserved populations.

But there is a way to change the equation. The answer is value-based care.

Value-based care is specifically designed to redirect healthcare dollars toward keeping people healthy as far upstream as possible. FQHCs are already deeply engaged in that work, and they’re extremely successful at it. Value-based reimbursement models give FQHCs the opportunity to do more of what they’re good at – and get rewarded by bolstering their long-term sustainability.

The challenge is funding FQHCs in a way that makes sense within our current system and prepares us for a new approach in the future. We have to ensure that FQHCs feel included in the broader health ecosystem and that they can work well with their partners across the care continuum. That means shifting our thinking on how to design value-based care models for providers who serve Medicaid beneficiaries and the uninsured.

Want more on what value-based care means for FQHCs? Download our guide.

Unpacking the challenges of value-based care for the safety net population

Photo of a doctor smiling at his desk wearing a stethoscope

Photo by Ivan Samkov

Historically, most value-based care models have been designed with Medicare in mind. They’ve been successful because the Medicare population is relatively stable: once someone ages into Medicare, they tend to stay there. As a result, providers have a very clear sense of who their attributed patients will be, what their health conditions are, and how they interact with the healthcare system. That makes it relatively easy to monitor performance, control spending, and determine incentives for a very similar population over a multiyear period.

But Medicaid is very different. People will often qualify in and out as their financial situation changes. Sometimes they’ll get a good job and find commercial coverage; sometimes they’ll be unemployed or underemployed and go back on Medicaid. In between, they might spend a period of time without any coverage.

Payers and providers are constantly losing sight of these individuals, so it’s extremely difficult to track spending and manage outcomes for specific patients year over year.  

That’s the biggest roadblock for Medicaid on the journey to value-based care. We need better ways of designing value-based care models to compensate for the differences between these groups so we can incentivize providers appropriately for the challenges they’re facing with these transient populations.  

Aligning value-based care models to the reality of the FQHC environment

We can make value-based care more viable for FQHCs by moving away from following individuals over time and embracing a broader, population-based way of thinking.  

For example, in a given performance period, an FQHC might lose touch with 20 of their Medicaid beneficiaries with diabetes. But they’re likely to gain 20 different beneficiaries with diabetes in the same period.  

Assuming all of those individuals require a similar level of chronic disease management, we can reward providers for delivering an expected number of chronic disease management services at an expected level of spend – regardless of the fact that different individuals are actually receiving that care.  

If FQHCs continue to consistently and methodically provide proactive, preventive care for all the people who rotate in and out of their patient pool, we will move the needle for the entire population over time. After all, a rising tide lifts all boats. We simply need to better reflect these interventions in our contracts and our quality measurement models so we can successfully address our biggest cost drivers over time.

Empowering FQHCs to architect a better, value-driven future

FQHCs need to recognize that they have the power to make these changes happen. In fact, they have a lot more negotiating leverage than they think they do. Collectively, FQHCs represent nearly one in four Medicaid beneficiaries – that’s a huge advantage when sitting at the table with a health plan.  

But too often, an FQHC will accept a contract at face value because they don’t always have the resources, the data, or the experience to negotiate on their own behalf. They might feel like they have to take whatever is offered to them. That’s absolutely not the case.  

We founded Yuvo to show FQHCs exactly how much clout they have in these situations and to equip them with the knowledge and experience to drive positive changes in the way value-based care plays out for them.  

Our goal is to show FQHCs that there is strength in numbers - and show the broader healthcare ecosystem that FQHCs are absolutely essential for our society. I know firsthand that FQHCs are a lifeline for people who struggle to access high-quality healthcare.

Infographic displaying the case for VBC in numbers: 8.5 billion saved, 60% of all health payments linked to quality and value, 80% of Medicaid dollars, aiming for 100% of Medicare beneficiaries, 48 states involved as of 2019

As a former patient myself, I will forever be grateful for the FQHCs that gave care, support, and dignity to me and family regardless of my insurance status. My mission at Yuvo is to ensure that everyone in every community can have access to similar services from caring, knowledgeable, creative, and capable providers driven by their passion for community healthcare.

Together, we can design the future we want to see by collaborating with payers from that position of power. We can create policies and contracts that accurately reflect the world FQHCs live in.

We’re not saying it will be easy, but we know that FQHCs never shirk from a challenge. With access to policy experts, contracting opportunities, and peer support, FQCHs can tap into the enormous opportunities to succeed with value-based care.

As co-founder and CEO of Yuvo, I’m passionate about helping FQHCs pursue a more sustainable future.  Value-based care holds so much promise for improving outcomes, especially among the most vulnerable patients. By working together, we can help all FQHCs take advantage of existing opportunities while positioning themselves for long-term success in a dynamic, exciting environment.

Interested in learning more about value-based care? Download our free checklist to prepare for success.

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