Are Quality Metrics Really Delivering Quality Outcomes among FQHCs?

Quality metrics that actually matter for FQHC populations cannot be found on a claim

By Mike Hofmeister , VP, Primary Care Market Solutions

I recall the early days of accountable care organizations (ACOs) and managed care organizations (MCOs), where many of us thought that identifying a few quality metrics and checking a few boxes in the EMR system was the key to improving patient outcomes and reducing costs.

However, not only did this add administrative burdens for clinicians, it also concealed the whole story for many patients of federally qualified health centers (FQHCs). Within most FQHCs populations, many outside reasons may prevent a person from managing their health and being compliant with their doctor’s health plan. The extreme challenges within the FQHC patient population represent financial and care delivery opportunities that do not easily fit within traditional quality measures.

As the healthcare industry accelerates the transition to value-based care, also known as pay-for-performance, FQHCs must move beyond traditional quality measures to capture the full picture of what it takes to manage the health of their populations. To successfully navigate this transition, FQHCs are looking more strategically at health equity and collaborating to improve health outcomes while reducing costs.

The Current State

Today, value-based payment programs represent less than 10% of most FQHC revenue, according to a ?recent survey of more than 50 mid- to large-size FQHCs done by Porter Research. However, greater than 50% of survey respondents expect those percentages to increase rapidly over the next 12–18 months. However, as payers push more aggressively toward more financial risk-bearing arrangements tied to quality measures, a perfect storm approaches.

Navigating the Storm

FQHCs are already under tremendous pressure, given healthcare workforce shortages, increasing regulatory mandates, and the growing reach and complexities of the care services required among FQHC populations. They are already responsible for providing care to our nation’s most vulnerable populations that often do not have the resources to address their health challenges. This may be lack of transportation, lack of access to the right nutrition or medication, insufficient housing, or not enough education to manage their chronic conditions.

By focusing purely on standard quality metrics as the drivers for determining reimbursement rates, payers are putting FQHCs at risk of not being able to fulfill their mission of providing care for our nation’s most vulnerable citizens. To remain sustainable, FQHCs may be forced to turn to hospitals—even though 83% of FQHCs are reported to be fiercely committed to their independence from hospitals.

To ensure FQHCs can be successful in this transition, we at NextGen Healthcare are investing in several key initiatives that we believe will help the FQHC community successfully navigate the path toward value-based payments. These initiatives are focused on helping FQHCs collaborate more effectively with each other, sharing meaningful benchmarks with each other, equipping clinical teams with FQHC-specific workflows, collaborating on how best to deliver whole-person care, and making quality management and reporting actionable.

Get Involved

As the leading electronic health record (EHR) system among FQHCs, NextGen Healthcare offers multiple opportunities to get involved with other FQHCs around the country. One such opportunity is the NextGen Community Health Collaborative: A free, industry-wide collaborative of FQHC leaders and organizations. If you know of an FQHC leader who would like to be involved, please share this post or help them get connected to me. Together, we can help FQHCs stay true to their mission while also being successful in the next generation of value-based payment models.