In a healthcare environment that is increasingly recognizing the importance of a value-based approach to healthcare delivery, partnerships between health systems and Federally Qualified Health Centers (FQHCs) provide a tremendous opportunity for both entities to invest resources thoughtfully, efficiently, and strategically to address community health needs. For health systems that own or are participants in risk bearing organizations (RBO) such as a clinically integrated network (CIN), independent physician association (IPA) or accountable care organization (ACO), including CMS MSSP ACOs and ACO REACH, it is important to assess how FQHCs may fit into or interact with an existing RBO.

FQHCs can serve as a critical partner in expanding access to primary care, preventive care, and diagnostic services for vulnerable populations who are traditionally underserved, including Medicaid, dual eligibles, low-income Medicare, subsidized exchange and uninsured in particular. Drawing on close relationships with community-based organizations, FQHCs are also well-equipped to address social determinants of health such as homelessness, food insecurity, and transportation access. By leveraging enhanced care coordination through partnership with FQHCs, health systems participating in value-based arrangements can better perform financially and improve quality by managing patients’ total cost of care and enhancing clinical continuity between the FQHCs and the health system.

For FQHCs, health system partnerships can improve care coordination for patients with complex care needs and enhance access to high performing specialists, thereby also improving clinical continuity for vulnerable patients and total cost of care reduction. Shared resources and electronic health records can strengthen the infrastructure required for more robust care management and analytics to meet community health needs. Additionally, such collaboration may help FQHCs to expand service offerings and implement new programs and care models aligned with their community-oriented mission, vision, and values.

Below are 5 partnership strategies to capitalize on the synergies between health systems and FQHCs, whether through the same RBO or coordinated RBOs, enabling both entities to better serve the community and improve financial and quality performance:

1. FQHCs and health systems should develop coordinated discharge processes and workflows for a smooth care transition following discharge from inpatient, emergency department or urgent care settings back to primary care. Standardized communication channels and discharge protocols can ensure patients are better equipped with a clear care plan and minimize risk of readmission.
2. Health systems should consider leasing space to FQHCs in strategic locations to decant congested clinic space and emergency departments, directing appropriate patients to their Health Center partner. This can relieve capacity challenges and bottlenecks that impact patient access, improving patient satisfaction.
3. Health systems may consider fully transitioning clinics with a high volume of Medicaid, and in some cases uninsured, patients into an existing FQHC. This arrangement promotes the long-term financial sustainability of these clinics by allowing access to enhanced reimbursement rates – expanding reach to underserved communities – while maintaining close health system partnership for continued care coordination.
4. FQHCs and health systems can partner to integrate and improve care management systems, expanding access throughout the community and leveraging health IT resources to inform targeted initiatives. Integration of care management systems and electronic health records can help health systems and FQHCs proactively identify high-risk patient populations and develop programs aimed to reduce unnecessary hospital admissions and address chronic disease burden.
5. Health systems may consider providing specialist physicians to FQHCs through a Physician Service Agreement (PSA). This arrangement enhances access to specialty care (e.g., cardiology, dermatology, orthopedics) within the FQHC setting under a more financially sustainable reimbursement rate while maintaining appropriate referral pathways.

By leveraging shared resources, clinical and non-clinical expertise, and access to underserved patients throughout the care continuum, successful partnerships between health systems and FQHCs can be an effective model to deliver more sustainable, equitable, and effective healthcare.

COPE Health Solutions has extensive experience in Medicaid, Medicare, dual eligible and commercial revenue optimization strategies, including value based care enablement. For more information on Medicaid and FQHC strategies, value-based care alignment and performance improvement options reach out to COPE Health Solutions at info@copehealthsolutions.com.