Preparing for success with value-based care: A checklist for Federally Qualified Health Centers

For many federally qualified health centers (FQHCs), value-based care is brand new territory. Historically, community health centers have struggled to find a place in the nation’s ongoing efforts to reform the healthcare reimbursement landscape, as early efforts focused more on the relationships between inpatient care and private physician practices.

As we enter the second decade of the Affordable Care Act, however, that’s starting to change. Policy, providers, payers, and patients are becoming more closely aligned around the idea that proactive, comprehensive primary care is key to reducing costs, improving outcomes, and producing positive experiences.  

And no one does primary care better than an FQHC.  Community health centers are well-known leaders in holistic care delivery. They have extensive experience addressing the social determinants of health (SDOH) and measurably improving outcomes in the most challenging of communities – all the hallmarks of an organization that can succeed in the modern value-based environment.

Download our easy-to-use checklist for FQHCs getting started with value-based care.

But how can FQHCs like yours get started with value-based care?  

How can you identify the models best suited for your capabilities and develop the tools and strategies you need to maximize your ability to earn shared savings?  

You can start by using this checklist to assess your readiness and start building momentum toward new possibilities for financial and clinical success.  Here are the more important areas to consider when exploring the world of value-based care.

Cultural alignment and organizational readiness

Value-based care represents a major shift away from the fee-for-service mentality of the past.  

Participating providers become clinically and financially accountable for better outcomes in ways that tend to challenge most traditional organizational structures, so you need to develop a clear understanding of how your FQHC has operated in the past – and what it has to do in order to meet expectations in the future.  Ask yourself if you have the following:

• A defined set of measurable, realistic, time-bound goals, including an ideal timeline for achieving shared savings  
• A clear framework for measuring progress and ensuring internal accountability for ongoing decision-making
• A shared consensus around your appetite for financial risk and comfort with pursuing higher risk, higher reward contracts over time
• An understanding of your current payer mix, their value-based care offerings, and the potential for forging new relationships with additional payers in your region
• A plan for educating staff, recruiting clinical champions, and securing buy-in from stakeholders across the entire organization
  

Clinical coordination and care quality

Coordinated, team-based care is an essential component of value-based care.  Staying one step ahead of rising risks and gaps in care allows providers to perform highly on clinical quality measures while reducing costs and improving outcomes.  You will need:

• Knowledge of how to deploy team-based care and integrated clinical practice to treat patients holistically, maximize clinical resources, and allow all providers to work at the top of their license
• A network of high-performing clinical partners, including specialists, inpatient facilities, urgent and emergency care providers, and behavioral healthcare providers
• Familiarity with the principles of population health management and the role of preventive care in improving chronic disease management and reducing resource utilization
• Strong connections with community-based organizations, social services, and other non-clinical partners to address the social determinants of health
• Physical space to accommodate changes in team-based clinical practice strategies or co-locate complementary services such as behavioral healthcare, dental care, or social workers
  

Technical maturity for data-driven decision making

Access to the right information at the right time is crucial for ensuring that all patients get the personalized services they need to manage their health most effectively.  Your FQHC should consider implementing technology tools with the following capabilities to make sure providers have actionable insights at their fingertips to deliver optimal care and measure their performance.

• Risk stratification technology to manage populations, identify high-risk individuals, and close gaps in care before they result in expensive crisis events
• ‍Risk adjustment and coding tools to ensure you are receiving the most accurate, appropriate reimbursement for your unique patient population
• Health information exchange connections with regional provider partners to improve care coordination and keep primary care providers informed about specialist utilization or recent hospital events
• Performance monitoring and quality measurement tools to help providers continuously improve care delivery and patient outcomes
• Patient-facing tools such as patient portals, secure messaging, telehealth, online bill pay, and online scheduling to foster engagement and help patients take charge of their own care
  

Readiness for contracting

With these fundamental building blocks in place, you can start turning your attention to contracting in specific models that might best fit your FQHC’s unique competencies and long-term goals.  During this part of the process, you may wish to seek out expert advice and counsel from a partner with deep experience in value-based care and negotiating with payers.  They will help you assess whether you can check the following items off your list:

• A full understanding of how value-based care models are designed, including issues around patient attribution, risk adjustment, quality benchmarking, and shared savings calculations
• An analysis of your FQHC’s current financial status and projections for how value-based care participation may enhance your revenue cycle in the future
• A detailed breakdown of any upfront investments required for participation, such as the need for new technology or additional staffing
• An assessment of your strength when negotiating with a payer and options for improving your position by collaborating with other FQHCs to gain scale and influence in the market
  

Value-based care offers FQHCs new options for enhancing revenue, delivering high-quality care, and keeping underserved communities healthier and happier.  FQHCs are a natural fit for these models, and you shouldn’t let the possibilities pass you by.

How Yuvo can help

If you are interested in diving into the value-based care environment but have any questions or concerns about how you will handle some of the items on this checklist, we have answers for you.

Yuvo Health can provide the guidance, expertise, and access to contracts that you’re looking for.  With our experienced team of leaders in community health and healthcare reform, we can help your FQHC take advantage of emerging opportunities in value-based care.

To learn more about Yuvo Health and our independent provider association (IPA) specifically designed for FQHCs like yours, visit our website.