FQHC Medicare Services Meet Growing Needs and Generate Net Revenues

The federal Centers for Medicare and Medicaid (CMS) is financially incentivizing FQHCs to focus on more proactive prevention, early intervention, and chronic care management with Medicare patients. These include services like the Annual Wellness Visit (AWV), screenings for a number of conditions, chronic disease management, weight loss,, behavioral health and addiction management, and other services.

FQHCs can build these services by reaching out to their own older adult patient population, as well as reach out to other older adults through elder-serving organizations like Senior Centers, faith communities, and other groups. This outreach and service expansion meets the expanding needs of the fast-growing older adult population in a way that builds net revenues and financial sustainability. Health centers can expect to see  “triple bottom line benefits.” 

  1. Older adult patients, helping them manage their health more proactively, with fewer health problems and high end costs related to deferred healthcare;
  2. FQHC’s own budget, providing significant ongoing net revenue, which can help significantly with a sustainable budget, providing excess revenues that can go into operating expenses;
  3. The community, by expanding and diversifying services in such a way that more older adults are able to stay in their homes for longer periods of time, stabilizing the community.

What Might an FQHC Expect to Accomplish?

FQHCs can build their base of services to older adults through inreach and outreach.  Inreach to already-existing patients is often the first strategy. There are often patients that may not have visited the health center for a year or more. The Annual Wellness Visit (AWV) is often an excellent way for FQHCs to begin to expand services to older adults. It provides for important screenings, a health plan with goals, referrals for other services (tests, chronic disease management, and behavioral health related care). When handled according to a rigid set of CMS protocols, the AWV and other services provide for needed care and help for people to manage their own health as a partner with their provider.

However, the work should not stop with inreach because HRSA data shows that most CHCs serve a lower percentage of older adults than exists in the population at large. What that means is that there is a very large marketing opportunity and potential to build out services and revenues. Outreach can include a wide range of activities targeted to the culture and unique needs of your region. Having a Senior Advisory Board at your FQHC can allow older adults themselves to help shape outreach that is meaningful, culturally relevant, and not demeaning. It is surprising how many well-meaning professionals have material that is unintentionally dismissive or demeaning to the elderly. A mix of communication strategies is usually best, older adults are a diverse group, with some preferring direct contact and others moving fast and liking email. Presentations to Senior Centers, faith communities, financial planners and others serving older adults can increase your CHC’s profile and build referrals.

Medicare’s Suite of Services

FQHCs have the opportunity build out what I call a Suite of Medicare Services, working with a cross-functional team that is involved in all aspects of care for the Medicare patient. From the initial calls and emails, to scheduling, clinical teaming, QI to ensure all CMS requirements are met, in-system referrals for other care, follow-up, billing, reimbursement, budget analysis, and client feedback — all require coordination. Cross functional teams that are expertly managed, actively work together, and communicate around the electronic medical record (EMR) can achieve exceptional results.

CMS is providing high rates of reimbursement for these prevention and early intervention services because they have found that (1) older adults working to actively manage their healthcare results in better health and lower overall disease costs, and (2) FQHCs provide, overall, some of the most effective care of all types of medical groups.

It will be interesting to see how FQHCs build out these services in the next few years. There are already a number of important lessons learned, evidence based practice, and successful models.

Anne Hays Egan, February, 2018