3 ways Florida FQHCs can embrace the shift to value-based care

This article is an excerpt of “Sustainability in the sunshine state: How Florida FQHCs can leverage value-based care to stay ahead of regional challenges”. You can download the entire whitepaper for free here. 

Florida’s minimalist approach to Medicaid is getting even more hands-off. As the state completes its post-pandemic “unwinding” process, at least 1.9 million people are unable to maintain enrollment due to coverage redeterminations. 

As a result, Florida now has a 13.9 percent uninsured rate compared to the national average of 9.5 percent. And with recent federal efforts trending toward additional rollbacks of public insurance programs, those rates might increase further in the next few years.

This is hugely concerning for the state’s 47 health center organizations who have already been struggling with shrinking Medicaid reimbursements and now have to find new revenue streams to make up for potentially increased levels of care for a greater number of uninsured patients.

Fortunately, there are emerging options to strengthen financial sustainability in this uncertain environment, especially as Medicaid enters a new phase of implementation in 2025: value-based care (VBC) models and other quality-centered initiatives that offer enhanced incentive opportunities for the type of proactive, comprehensive care that FQHCs are already so adept at delivering. Here’s how your Florida-based FQHC can proactively prepare for these upcoming changes.

3 ways Florida FQHCs can embrace the shift to value-based care

1. Define shared goals and objectives for the organization

While Medicaid tends to represent an influential portion of the average Florida health center’s incoming dollars, it’s not the only revenue stream that can (and will) involve value-based care models. 

Traditional Medicare, Medicare Advantage, and commercial insurance plans are all moving toward VBC, some even faster than Medicaid, which means executive leaders need to work closely with clinical and administrative champions to define the organization’s appetite for financial risk, as well as its capacity for clinical transformation, using historical data and relevant performance indicators to help calculate the potential impact of various VBC options.

Some quality improvement initiatives may require up-front investments in technology upgrades, additional staff, physical space, and community-based activities, so Florida FQHCs should ensure they fully understand their current financial health, reliable revenue streams, and ability to devote resources to high-priority areas.

Once established, the organization’s goals should be clearly and consistently communicated to staff members alongside foundational education on value-based care and its likely impact on individual workflows, organizational culture, and patient relationships.

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2. Develop strategies to adapt to changing clinical and operational needs

Financial incentives are more than just a different way of getting paid. They are designed to be a catalyst for clinical and administrative change, which in turn requires a holistic transformation in the way providers deliver – and the way patients experience – clinical and non-clinical services. 

Maximizing opportunities to earn incentives will require Florida FQHCs to better understand how to document and code for services to develop accurate risk profiles for patient populations, as well as how to use technology to stratify and prioritize these populations for targeted services, exchange health information with partners to ensure continuity of care, and accurately measure the impact of their results on outcomes, spending, and process measures.

FQHCs will need to develop both shorter-term and longer-term strategies for making necessary investments in digital tools to assist with these activities, as well as with adjusting workflows, reallocating resources, and staying ahead of the latest developments to ensure speedy but sustainable transformation.

3. Align with peers and partners to engage in advantageous contracts

Fortunately, FQHCs don’t have to plan and execute all these activities on their own. Instead, they can partner with entities who can assist them with accessing more advanced contracts and succeeding with quality and financial goals. FQHCs should not discount the value of previous contracting expertise and deep knowledge of Florida’s unique community health space. 

To establish high-value relationships, FQHCs should look for partners who are able to provide detailed insight into how to design contracts that are most advantageous for the FQHC – and be unafraid to firmly negotiate key terms when sitting at the table with a health plan.

This is especially important in a state like Florida, where powerful market dynamics can sometimes feel overwhelming for FQHCs who are attempting to enter an unfamiliar and highly nuanced environment. FQHCs that work together with a VBC expert can increase their bargaining power and work more effectively with plan representatives to design models that are fair and beneficial for all parties. 

By coming together in innovative ways to commit to health system transformation, Florida FQHCs can gain access to the knowledge, administrative resources, and support they need to make the most of their opportunities.

Yuvo Health can help 

Now is the time to start building momentum toward VBC. FQHCs that recognize this transitional moment and adapt to it will be better positioned to achieve their goals and continue to support their communities with exceptional and sustainable care.

As both an MSO and an IPA, Yuvo Health has experience leading other community health centers through these changes. 

As Dr. Rita Bilello, CEO of at Metro Community Health Centers, put it:

“With Yuvo taking this challenge on and eliminating the barriers, it gives FQHCs a voice in the conversation but also allows us, to some degree, to prove what we’re capable of doing.” 

In particular, we can help your team:

• Enter into higher quality VBC contracts with extensive bargaining power
• Gain access to revenue where Yuvo Health assumes the downside risk
• Overcome common hurdles with technology, including data collection, processing, and analytics
• Organize care coordination, patient outreach, planning, and engagement
• Make data-driven decisions that result in increased quality of care and revenue

You can learn more about us here or schedule a meeting today.