Developing Federally Qualified Health Centers into Community ...

EXECUTIVE SUMMARY
Across the nation, states are seeking to bolster the performance of Medicaid
primary care providers in order to hold down costs while improving beneficiaries’ health.
In particular, more than 37 states are developing or implementing strategies that seek to
improve primary care delivery through the creation of medical homes. A majority of U.S.
physicians work in small to medium-sized practices, which often do not have the
resources to provide complex care coordination, behavioral health care, extended hours,
and other services needed to function as medical homes. As a result, such practices are
frequently left out of medical home reform efforts. Connecting such practices to federally
qualified health centers (FQHCs)—which provide comprehensive primary care
services—could help improve the health of vulnerable populations and potentially reduce
costs by achieving efficiencies and sharing scarce resources.
What Is a Federally Qualified Health Center?
Federally Qualified Health Center is a designation from the Bureau of Primary Health Care and
the Centers for Medicare and Medicaid Services given to a nonprofit public or private clinic that is
located in a medically underserved area or provides care to a medically underserved population.
FQHCs must provide a detailed scope of primary health care as well as supportive services to all
patients, regardless of their ability to pay. They must be governed by a board, of which the
majority members must come from the community served by the FQHC. Most, but not all, FQHCs
receive federal grant funds under the Health Center Program, Section 330 of the Public Health
Service Act.
By fostering connections between FQHCs and other Medicaid providers, states
may be able to connect beneficiaries with services needed to help them manage their
health and reduce costly visits to hospitals. FQHCs’ mandate to provide a detailed scope
of primary and preventive health care and support services, coupled with their access to
federal funds, gives them expertise and resources that might be leveraged in collaborative
relationships with states and private practices. In addition, 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.
With support from The Commonwealth Fund, the National Academy for State
Health Policy sought to identify states and FQHCs that are collaborating to build
community networks to make medical home services available for vulnerable
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