Developing Federally Qualified Health Centers into Community ...

• HIP provides a stream of insured patient referrals for other FQHC services, most
notably dental care. While some FQHCs do not have spare capacity, others are eager
to take advantage of these additional opportunities for revenue and have been able to
hire more staff and significantly expand operations. An FQHC in Missoula reported
that participation in HIP has brought in more covered visits to its behavioral health
specialists.
• An FQHC looking to provide care management services for its patients may not have
sufficient internal demand to justify hiring a care manager. For example, an FQHC in
Butte described its previous care management services as being a ―patchwork.‖ HIP
has allowed this health center to hire a registered nurse care manager, which also
gives it more credibility, and consequently better relations, with hospitals and
providers.
• HIP provides training opportunities and ongoing funding for FQHCs to develop
expertise in care management. Health centers are finding that this furthers their own
efforts to develop into high-performing medical homes that can better serve their
existing patient bases.
The PCA and FQHCs have identified opportunities for improvement:
Avoiding care manager burnout. The nature of HIP demands that care managers
work almost exclusively with a sick, high-needs population. Although the turnover
among care managers has been quite low, FQHC staff are acutely aware of the need to
guard against staff burnout as the program matures. Suggestions to do so include enlisting
other staff, such as receptionists and community health workers, to help care managers
contact and follow up with patients.
Focusing resources on new beneficiary outreach. HIP care managers spend a
great deal of time trying to establish and maintain relationships with hard-to-reach
clients. (As mentioned previously, at any time about one-third of HIP beneficiaries are
unresponsive or unreachable.) To address this challenge, care managers need the help of
administrative support staff with strong ―sleuthing‖ skills, as well as access to timely
information from Medicaid. Such information from Medicaid, ideally delivered through a
shared database, could provide a care manager with valuable tips, such as the location of
a pharmacy where a patient picked up a recent prescription.
Accessing clinical information. HIP care managers are not always able to access
up-to-date clinical information from private providers, hospitals, and other caregivers.
For obvious reasons, this can complicate care management. Electronic health information
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