$50B Rural Health Transformation Opportunity: What FQHCs and Rural Providers Need to Know
The One Big Beautiful Bill Act, signed into law earlier this summer, created the Rural Health Transformation (RHT) Program, an initiative launched by the Centers for Medicare & Medicaid Services (CMS) to help rural communities redesign their healthcare delivery systems, expand access to quality care, develop the workforce, and improve health outcomes through innovation and support […]
Federally Qualified Health Centers Leveraging Analytics to Enable Value-Based Care Success
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) […]
CMS Announces Key Updates to AHEAD: What You Need to Know
The Centers for Medicare & Medicaid Services (CMS) recently announced updates to the Achieving Healthcare Efficiency through Accountable Design (AHEAD) model, a state total cost of care model that Maryland, Connecticut, Hawaii, Vermont, Rhode Island and Downstate New York will participate in. While certain changes affect state requirements, key changes affecting hospitals and providers include: […]
Transforming Complex Care: Driving Outcomes and Reducing Costs with Care at Home Solutions
I. Executive Summary Care at Home Solutions is an innovative, community-based program designed by COPE Health Solutions to support high-risk, medically complex patients where they feel safest, at home. Through a physician-led, multidisciplinary care team, we aim to improve outcomes, reduce avoidable utilization, and restore connections to ongoing care. II. The Problem: Gaps in Post-Acute […]
Why Most FQHC Strategic Plans Fail—and How to Build One That Delivers
Strategic planning has always been a requirement for Federally Qualified Health Centers (FQHCs). In today’s rapidly evolving market, the right strategic plan—centered on value-based payment (VBP) and value-based care—is also a competitive differentiator. CMS is accelerating the shift to VBP, and managed care plans are becoming more selective with their partnerships. FQHCs that treat strategic […]
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 expected reductions in Medicaid and ACA marketplace membership to cause a growth […]
6 Things to Know About CMS’ Recent ACO REACH Model Updates
The Center for Medicare and Medicaid Services (CMS) recently issued a notice announcing changes to the ACO REACH for Performance Year 2026. The ACO REACH currently is projected to conclude at the end of 2026, but there is ongoing speculation around a potential expansion. CMS’ intent of these changes is to improve model sustainability by […]
Policy Pulse Check: What Key Medicare Updates So Far in 2025 Mean for ACOs
As we approach the Medicare Shared Savings Program (MSSP) Phase 1 application period for Performance Year (PY) 2026, now is the time to take stock of how changes in the Medicare policy environment affect current and prospective Accountable Care Organizations (ACO). For a more detailed review of application timeline and strategic considerations, refer to our […]
Considerations for Hospitals and Providers Amidst CMS Released AHEAD V3.0 Financial Model
CMS has indicated that the States Advancing All-Payer Health Equity Approaches and Development (AHEAD) model is moving forward, and the pre-implementation period is well underway in awarded states Maryland, Connecticut, Vermont, Hawaii, Rhode Island, and downstate New York. AHEAD is a voluntary total cost of care model whereby CMS encourages a state-level, multi-sector approach to care that […]
Four Key Considerations For Recent FQHC New Access Point Applicants
In summer 2024, the Health Resources and Services Administration (HRSA) released a long awaited Notice of Funding Opportunity for Health Center Program New Access Point (NAP) applications allowing qualified entities to apply for Federally Qualified Health Center (FQHC) designation. It is anticipated that HRSA will award 77 grants, of up to $650,000 each, with the […]