Developing Federally Qualified Health Centers into Community ...

Drawing on extensive interviews with state and local stakeholders conducted
during a site visit to Montana, this report takes a close look at the state’s Health
Improvement Program. In addition, we used telephone interviews to explore two other
models of care:
• A North Carolina FQHC that led the formation of a network involving FQHCs,
hospitals, private practices, and other organizations that provides comprehensive
services to help private Medicaid practices operate as medical homes.
• An Indiana FQHC that provides urgent care services to the surrounding community
and has developed referral relationships with private practices, many of which are
focused on avoiding emergency department visits.
In each of these three examples, the states played a direct or indirect role in the
development of FQHCs as a community network. The Medicaid agencies in Montana and
North Carolina took a leading role in establishing statewide networks to support all
Medicaid practices. North Carolina took a bottom-up approach by letting local practices
decide which infrastructure worked best for them. Montana took a top-down approach,
with the state Medicaid agency designating the infrastructure and getting the network up
and running in less than a year. In Indiana, an FQHC offered private practices and their
patients an alternative to the emergency department for urgent care. A Medicaid managed
care payment policy that paid providers on a capitated basis created an environment in
which urgent care centers could flourish.
These three examples offer strong evidence of FQHCs’ leadership, vision,
creativity, and willingness to help states strengthen their primary care delivery systems.
This report aims to promote conversation among states, FQHCs, and other stakeholders
about new possibilities for collaborating to meet the increased demand for care under the
expansion of Medicaid through federal health reform. It also highlights potential funding
opportunities that federal health reform may bring to encourage and support such
collaboration and innovation.
MONTANA’S HEALTH IMPROVEMENT PROGRAM
Montana’s Health Improvement Program (HIP) relies on the state’s FQHCs to provide
care management for high-risk beneficiaries of Passport to Health, Montana Medicaid’s
primary care case management (PCCM) program. 6 Montana Medicaid seized on an
opportunity to rethink its Medicaid delivery system to develop this innovative program.
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