Developing Federally Qualified Health Centers into Community ...

complement of health care and support services; providers through the National Health
Services Corps; and eligibility to apply for government-sponsored malpractice coverage.
FQHCs also have expertise in providing comprehensive medical homes to vulnerable
populations, including linkages to health and social services. In addition to helping
private practices, FQHCs may find that by entering into collaborative relationships with
states and private practices, they strengthen their own financial position, advance their
quality goals, improve their staffing mix, enhance the continuum of care and the kinds of
services available to their patients, and further their mission.
The Affordable Care Act provides resources that may help states develop a better
primary care infrastructure for Medicaid populations. These include significant federal
funding for health center operational and infrastructure expansion, along with additional
funding to improve primary care practice delivery. 4
The inspiration for this report came from Montana Medicaid’s Health
Improvement Program. Conceived by the state Medicaid agency, the program has
entailed shifting an existing budget for disease management from an out-of-state vendor
to FQHCs across the state. FQHC-based staff members provide care management
services for Medicaid beneficiaries, including those who do not receive their primary care
from the FQHC. The state has developed ―what’s on hand‖ into a community resource or
―shared utility‖ of services that may improve care delivery for all Medicaid beneficiaries,
as well as reduce state costs. This model may have broad appeal for other states.
With support from The Commonwealth Fund, the National Academy for State
Health Policy (NASHP) sought to identify other examples of state and FQHC
collaborations that involve sharing services among practices to improve the delivery of
comprehensive primary care. To do so, we interviewed a number of federal and national
experts, scanned the literature, and surveyed state Primary Care Associations. Although
there is increasing interest in developing resources to help small and medium-sized
practices become medical homes, we did not find many models that involved state and
FQHC collaboration. 5 According to those we interviewed, there may be several reasons
for this: 1) state officials and FQHCs may not be aware of the potential for FQHCs to use
their resources for activities and services provided outside of the four walls of their
facilities; 2) the collaborative model may not be appropriate in certain types of
communities or delivery systems; and 3) the inspiration and leadership needed to deploy
such an innovative model may not be present.
2