Medicare Annual Wellness VisitsThe Annual Wellness Visit (AWV) is a Triple-Bottom-Line Win for CHCs, and especially for CHCs that are Federally Qualified Health Centers (FQHCs). The win is for the patient and their family, the community, and the FQHC’s financial bottom line.
Here’s the rub: The AWV represents an excellent way to build the relationship with patients, a needed service, with excellent reimbursement rates. But, the federal Centers for Medicare and Medicaid (CMS) and other researchers report that the number of health centers involved in this is growing, but remains small. Many researchers believe that the community health centers are underserving the Medicare population.
Why is this needed and well-reimbursed service underutilized?
Recent articles by multiple colleagues about FQHCs needing to attract more Medicare patients got me to thinking about why this is a challenge.
- Is there a need?
- Would Medicare patients receive better care from FQHCs?
- Is the Medicare reimbursement system beneficial to FQHCs?
- What are the barriers to FQHCs building successful plans to expand services?
In an excellent article, Medicare Patients Need Community Health Centers, David Wilson of Innovative Health Media explained that when health centers don’t focus on attracting Medicare patients they overlook a neglected and often very needy group of patients. In fact, his article explains that the CMS funding formulas for Medicare services provided by FQHCs is pegged so that low to moderate income Medicare patients are better served in FQHCs. The CMS Prospective Payment System Flat Rate payments provide excellent opportunities for FQHCs to:
- Develop more proactive approaches to patient care, driven by patient needs and priorities, involving patients as partners in managing care; and
- Create a new revenue source that provides excess revenue over real expenses.
There are also a series of additional services for which FQHCs can bill, based upon the client’s situation and Medicare plan, including transportation, prescription programs, and chronic care management, and a wide range of preventive services pegged to the needs of older adults.
Medicare Annual Wellness Visit, provides a similar analysis. This article by HealthInsight, a nonprofit regional organization focused on health improvement, identifies the importance of this as a quality standard of care which more FQHCs need to develop.
Some of these CMS initiatives to support FQHCs, CHCs and CMHCs have come to the attention of the legal profession. The American Bar Association’s Health Law Section has indicated that FQHCs have a number of areas of competitive advantage, including (1) the wrap-around care given to clients who often have multiple, complex health conditions and life situations; (2) quality of care which is better than that offered by private practitioners, based on data gathered by the National Ambulatory Medical Care Survey Department of Health and Human Services; (3) and higher reimbursement rates offered to them by CMS for Medicare and Medicaid patients.
So why aren’t more FQHCs working to systematically build a bigger market share of older adults on Medicare?
The services are critically needed as a standard of care, and reimbursement systems are strong and flexible, so what’s the catch?
There are probably a mix of reasons, and state Primary Care Associations may want to survey members, or develop annual meeting workshops or discussion groups about this important topic. From my experience in research and consulting, it seems that many FQHCs are busy managing a raft of systemic budget cuts, policy challenges, data and IT issues, and system restructuring. The pace and depth of many of those challenges has increased over the past years.
That can keep an FQHC CEO busy 8 days a week!
Challenges often include the fact that FQHCs are historically focused upon serving those with the greatest financial need,. These normally include the uninsured and people on Medicaid, who have been marginalized because of the impact of Social Determinants of Health (like poverty, race and ethnicity, employment, and other factors). The large and fast-growing group of older adults of many income levels, races and ethnicities may still represent an under-reached group. Other challenges include program planning that shifts some of the emphasis toward programs and services for older adults, and taking time to develop outreach and marketing to people on Medicare.
Since the older adult population is growing nationally, and represents a huge prospective market in need of innovative and responsive care, the need is present and growing quickly. It’s an undertapped market. Since FQHCs are being reimbursed by CMS in a way that supports integrated care with a mix of services, the FQHCs are better clinically able to respond to the complex health needs of many older adults. They are also better positioned financially to respond, as CMS reimbursements are higher and more flexible for FQHCs than they are for private practice providers.
So, yes, the need is large and growing. FQHCs are uniquely positioned to respond.
It appears that targeted marketing is one important strategy that needs to be developed by FQHCs, along with expanding the mix of services uniquely pegged to the older adult population.
What are FQHCs doing to expand this population group, and what impact does this expansion have for the FQHC’s services and budget, and the older adults who are patients? Research by Sage Growth Partners on successful FQHCs indicates that many of those FQHCs that have been able to expand services to new markets have built the following capacities in their organizations: outstanding leadership; commitment to program excellence, tracking outcomes and process improvement; strong business and financial practices with successful revenue optimization; effective and integrated IT systems; policy and regulatory compliance; and creative target-population based marketing.
What are some models for successful outreach to the Medicare population?
Research by the National Association of Community Health Centers shows that the percentage of older adults on Medicare served by CHCs has grown in recent years, and is projected to continue to grow. The Kaiser Family Foundation has instituted two creative initiatives to help CHCs and FQHCs build their capacity to expand the numbers of older adults on Medicare.
Things are on the move, and it appears that FQHCs are responding – – and that response needs to continue to grow. Another article outlining strategies for building services and revenues for Medicare patients, will be posted soon.
Anne Hays Egan and her team at New Ventures provide a range of research, planning, and system development consulting services to help provider networks and communities build healthy, sustainable initiatives for healthier communities. If you’re interested in learning more about our research on this issue, or would like help identifying specific strategies your FQHC or system can use to build this important service and revenue stream, please contact us at: New Ventures Consulting, (505) 699-7706, or firstname.lastname@example.org.