Over the past decade, the federal government has started to reimburse for health care through a value-based payment structure. This shift will drive a more financially-sustainable, affordable, and efficient system. Unfortunately, health centers have not participated as fully as their capacity and expertise would allow. Policymakers can and should prioritize these safety net providers, both due to the size of the population served and their ability to connect value-based care to the shared goal of health equity.
Health centers should be supported as they evolve within the framework laid out by the Health Care Payment Learning and Action Network Alternative Payment Model Framework: 1) Fee for service linked to quality and value; 2) Alternative payment built on fee for service; 3) Population-based payment.
CHCs and federal payers should focus on a population health approach that rewards value, not volume. The Federal Government should shift CHCs from encounter-based care to enrollment-based care, while allowing CHCs to phase in the adjustment.
CHCs engaging in successful VBC should not be penalized by any new federal or state policy.
VBC at CHCs should facilitate team-based care that leverages all providers proven to deliver effective service.
CHCs should have the opportunity to evolve their participation in VBC, with the prospective payment system acting as a floor.
VBC at CHCs should prioritize health equity and include measurements of equity that are tied to payment.
Policy should enable VBC that addresses health related social needs.
Invest in capacity building for equitable, value-based care at health centers. Create a new partnership between CMS and the Health Resources and Services Administration (HRSA), to support the capacity building that many health centers need to fully implement a successful value-based care model.
Fund incentives and technical assistance for states seeking to establish, expand, or improve their alternative payment models (APMs) with federally qualified health centers.
Continue to implement value-based care pilots that encourage participation from FQHCs. The Centers for Medicare and Medicaid Innovation (CMMI) has announced multiple models that specifically target FQHCs. CMMI should continue improving and iterating on these pilots for maximum success.
Increase technical assistance to states looking to work with FQHCs on value-based care. Examine existing APMs, identify barriers to success, and support sharing of best practices.
Clarify and improve policy related to MCOs to ensure successful value-based care models with FQHCs. Medicaid should clarify that services that address the social determinants of health can be considered medical costs for purposes of calculating medical loss ratios, and that services provided by FQHCs to address the social determinants of health can be quality-improvement activities.
Incorporate risk adjustment measures into value-based care models that include safety net providers. Social risk factors must be incorporated into risk adjustment models for value-based care in Medicare and Medicaid to provide more accurate benchmarks for participants.