Federally Qualified Health Centers (FQHCs) are a crucial health care access point for underserved and uninsured communities. Yet, FQHCs face challenges with maintaining financial stability when relying solely on revenue from Prospective Payment System (PPS) rates, which tend to lag behind rising expenses. To diversify their revenue streams, FQHCs should consider pursuing Value-Based Care (VBC) arrangements and enter Alternative Payment Models (APMs) where available, which tie payments to quality and outcomes rather than volume. As the growth of APMs and value-based incentives encourage FQHCs to shift from a “volume to value” environment, access to accurate and timely analytics is critical to maximize earnings and minimize losses.

Analytics to Enable VBC Success in FQHCs

#1 Forecasting and Contract Modeling

To effectively forecast their chances of success in value-based arrangements, FQHCs must assess their previous years’ historical data and thoroughly understand their baseline performance. By modeling at least 3-5 years of claims history, FQHCs can understand their historical trends and identify targeted deficiencies that may impact VBC success. Comparing this data to value-based contract terms supports the identification of programmatic initiatives, tailored to specific patients, and gives FQHCs proactive intel  allowing for savings and upside earnings. Data-driven modeling can additionally support more targeted negotiations with payers, which can lead to greater downstream earnings.

#2 Real Time Data Integration

To identify impactful opportunities for quality or outcomes improvement, FQHCs should review their performance regularly through real-time data integration. Detailed and timely reporting enables end users to identify specific variables (i.e., certain populations, diagnoses, or providers) that are not meeting target metrics and address them through targeted initiatives. To identify these variables most effectively, FQHCs should utilize tools or platforms such as Analytics for Risk Contracting (ARC) to aggregate claims data, EMR data, Health Information Exchange (HIE) data and other relevant information available in real-time while awaiting additional data from payers. FQHCs participating in VBC arrangements can maximize the impact of their services by utilizing clear, real-time data to inform their strategy and operations, and ultimately provide the best possible care for their patients. Given the mission-oriented nature of FQHCs, these organizations typically leverage all sources available to them to provide the highest level of care; standardized integration not only reduces the administrative strain, but maximizes the impact and aligns the hard work with the incentives available in value-based contracts.

#3 Accurate and Concurrent Reconciliations

For FQHCs that do participate in value-based or quality incentive contracts, the databased reports from payer partners received are retroactive, covering a prior period of claims run out. It is important to validate and reconcile all reports to in-house analytics to ensure accurate data collection and dollars received, as these metrics could have a substantial impact on shared savings, losses, or quality earnings. Organizations that are equipped with tools that automatically aggregate their claims and EMR data can more easily, quickly, and accurately complete this validation process and confirm that all dollars earned are received. FQHCs may be accustomed to end-of-year reporting and reconciliations; in VBC models, waiting until the last months of the year to reconcile reports leaves little to no time to identify and address key gaps in performance.

To prepare for success in value-based agreements, FQHCs need a data-driven approach and advanced analytics that support the establishment of appropriate contract terms. Real-time reporting and data reconciliations, leading to identifying and addressing focus areas through targeted initiatives, are vital to ensuring FQHCs maximize all available revenue streams and maintain their role as safety net providers in underserved communities. FQHCs are charged with delivering high value care to complex patients through their mission and operating structure, and as such are prime entities to succeed in value-based contracting if they are equipped with the right tools.

To learn more about COPE Health Solutions’ market leading population health analytics tool, ARC, and how our subject matter experts can help your organization achieve revenue growth through value-based payments, reach out to our team at info@copehealthsolutions.com.