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The Staffing Math: What a Community-Based Workforce Costs — and What It Returns

Health plans know the problem: the members who drive the highest costs are the hardest to reach. They miss calls, skip appointments, and cycle through emergency departments and hospitals without ever engaging in traditional care management. Plans also know the solution: a community‑based, multilingual, in‑person workforce that meets members where they are. What plans often […]

The Engagement Gap: Why Complex Care Management Misses the Members Who Cost the Most

Across the country, health plans are investing heavily in complex care management programs. The logic is sound: identify high‑risk members, assign a nurse or social worker, and intervene before avoidable utilization occurs. Yet despite decades of refinement, one stubborn truth remains — the members who drive the highest costs are often the least likely to […]

The Next 340B Risk Is Operational Blindness

Since 2020, HRSA has posted hundreds of manufacturer notices affecting covered entities, while litigation involving contract-pharmacy restrictions and state protections continues to reshape the program. For community health centers, the risk is not simply that 340B is changing. It is that these changes can affect cash flow, financial performance, compliance, and patient services before leadership […]

5 Strategies to Enhance FQHC Performance and Financial Sustainability

Federally Qualified Health Centers (FQHCs) play a critical and innovative role in delivering comprehensive care to underserved communities, yet they face ongoing challenges in sustaining financial health and operational efficiency. With Medicaid and Medicare margins tightening as rate increases lag behind inflation, and reductions in Medicaid and ACA marketplace membership driving  growth in uninsured, proactive […]

New York State Rural Health Transformation Program

Executive Summary NYSDOH provided an implementation update on New York’s Rural Health Transformation Program (RHTP), funded by a first-year CMS award of $212 million1 covering 47 of the state’s 62 counties. The program is organized around four initiatives: Rural Community Health Integration (RCHI), Technology-Enhanced Primary Care, Rural Roots (workforce), and Investments in Technology Innovation and […]

Protecting Medicaid Coverage in a New Era of Eligibility Requirements

Across the country, Medicaid health plans are preparing for one of the most significant operational shifts since the end of the COVID-19 pandemic. New federal Medicaid eligibility and redetermination requirements established under H.R. 1 will require organizations to rethink how they engage members throughout the renewal process. And we’re only five months out. States have […]

Health Centers Can’t Grant Their Way to Revenue Stability — Medicare Is the Better Path

Community health centers face mounting financial pressure from rising costs, workforce shortages, Medicaid enrollment shifts, and federal funding uncertainty. While historically not a focus of health centers, Medicare is also becoming a larger share of the payor mix. In 2024, adults age 65+ were already the fastest-growing health center population, Medicare beneficiaries exceeded 11% of […]

Significant Changes Ahead: CMS Doubles Down on Value-Based Care In Proposed 2027 Medicare Rule

The Centers for Medicare & Medicaid Services (CMS) has released its proposed 2027 Medicare Physician Fee Schedule (PFS) and Quality Payment Program rule, signaling one of the most significant Medicare policy updates in recent years. While the proposal continues to put pressure on traditional physician reimbursement, it also reinforces CMS’s long-term commitment to expanding accountable […]