Developing Federally Qualified Health Centers into Community ...

ADDITIONAL POLICY OPTIONS TO PROMOTE COMMUNITY NETWORKS
Our interviews with stakeholders identified a number of federal and state policies that
could be improved or developed to provide further incentives to develop community
networks led by FQHCs.
• Although Medicare productivity requirements are being discontinued under the
Affordable Care Act, a 2005 Government Accountability Office report found that
seven states limit reimbursement for reasonable costs by setting performance or
productivity standards. These states stipulate the number of visits per year that a fulltime-equivalent
physician should provide and use similar guidelines for other
practitioners. Most of the states using performance or productivity standards relied on
the guidelines specified by Medicare. 38 FQHCs and Primary Care Associations
complain that such requirements constrain an FQHC’s ability to innovate. If providers
are being asked see patients too quickly, there is little time for innovations that
require Plan, Do, Study, Act approaches. Less emphasis on visit-based productivity
requirements is needed, particularly when FQHCs participate in innovative models
of care.
• A higher federal matching rate is needed for certain Medicaid services, now deemed
administrative, that help states sustain a network infrastructure. For instance, the
infrastructure that is needed to track clinical measures is currently paid for at the
lower administrative rate. CMS could consider providing a higher rate to help states
develop the infrastructure needed to manage community networks.
• Many private providers do not understand the federal requirements surrounding
FQHCs. On the other hand, many FQHCs do not appreciate the extraordinary
demands placed on high-volume Medicaid private providers. This lack of understanding
may impede collaborative relationships. Opportunities to help FQHCs and private
providers build trust and improve collaboration might help bridge this divide.
• Primary Care Associations or FQHC networks might serve as facilitators for
developing collaborations and sharing best practices across sites within a state.
Conceivably, a Primary Care Association or FQHC network might even serve as the
community hub itself, perhaps offering data analysis and support to practices.
Opportunities are needed to convene FQHCs, Primary Care Associations, FQHC
networks, and federal and state policymakers to collaborate on solutions to improve
the primary care delivery system.
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