Developing Federally Qualified Health Centers into Community ...

are many federal, state, and institutional barriers that make it difficult for FQHCs to
assume broader roles in their communities by forming collaborative networks with
private practices. These include:
• large differences in capabilities from one FQHC to the next;
• lack of incentives for private practices to participate in an FQHC-based network;
• need for the involvement of multiple payers;
• lack of information-sharing between providers;
• limited capacity to collect quality data for an entire episode of care;
• Centers for Medicare and Medicaid Services (CMS) productivity requirements for
FQHCs; and
• visit-based fee schedules that discourage innovation.
Federal health reform offers opportunities to overcome such barriers. The
Affordable Care Act creates opportunities for states and FQHCs to pilot community
networks, including:
• the Center for Medicare and Medicaid Innovation;
• enhanced funding for FQHCs;
• funding for community health teams;
• a new Medicaid state plan option for health homes for those with chronic conditions;
and
• primary care extension programs.
Conclusion
The creation of community-based networks to provide care management and greater
access to health care services may enable states to hold down Medicaid costs while
providing better care for beneficiaries. With the expansion of Medicaid through the
Affordable Care Act, already-stretched primary care practices will need to take on
additional Medicaid patients. Helping practices function more efficiently as medical
homes—particularly for patients with chronic illnesses—can help improve access to
high-quality care and control costs. In order for practices to function as medical homes,
they will need resources to ensure the delivery of timely, coordinated, and comprehensive
primary care. Many FQHCs have the infrastructure and expertise to help practices meet
medical home requirements and may be ready partners for states to develop as
community networks.
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