By David Wilson and Anne Hays Egan

After months of stress and concern, the funding cliff facing our Community Health Centers has been averted.   Congress will fund CHCs for at least 2 more years.  Although this is certainly a relief, We wish to express how important it is to recognize how this crisis gave us a very valuable and urgent lesson that we all need to learn.

Section 330 Funding is a boon that allows Community Health Centers to fund a population of people who are underserved.  The public health crisis that would have occurred if the funding cliff had been allowed to happen would have been profound with devastating consequences.. Can you imagine the public outcry that would follow as children and our poor lose access to what little healthcare they can afford, and seeing poor families suffer even more than they already are.

What we are left with after this crisis is that NOW is the time for all CHCs to reevaluate their budget and funding models.  We must take this last few months as a directive that federal funding may not always be there to support us. Building greater sustainability through more diversified funding will soften any potential future funding cuts.

Taking The Bull By The Horns:

We are strong advocates of filling the often serious void between Medicare patients and long term preventive care.  All of us are aware of the emerging crisis in Medicare with the Boomer generation reaching Medicare age in unprecedented numbers.  Prevention and long term promotion of wellness is a primary pillar in the solution to this crisis.  Healthier people cost less than sick people.

Medicare, through its PPS funding model, has made FQHCs the best place for their patients to receive care. Research has also shown that FQHCs, in general, provide better quality, more comprehensive care than the field in general. The PPS model of payment, allows FQHCs to charge the same amount for patients who are coming in to lose weight, prevent a heart attack or stem the spiral toward depression as they would for someone coming in to manage an existing chronic disease.  Herein lies a very real and achievable solution to the financial problems Community Health Centers are facing.

Increasing Medicare Census:

In a conversation with a FQHC about using Innovate Health Media’s program when asked what their Medicare numbers were.  We were shocked to learn their Medicare census was less than 2%.  When asked why, they told us, “We always encourage our Medicare patients to find new providers.”  Unfortunately, I believe that was very common practice in the past.  It is common for Community Health Centers to have remarkably low Medicare census rates.  Even looking at the number of Medicaid patients who are aging into Medicare, it is clear that these centers are losing those patients almost at the moment of transition.

With Medicare’s movement toward the PPS payment system, one has to wonder why FQHCs haven’t worked harder at retaining those patients? There may be many reasons, including the fact that FQHCs and CHCs are stretched, and often challenged to find the time for outreach. In our article, A Missed Opportunity in Community Health Centers we give details on the economic benefits FQHCs can achieve by utilizing the PPS to improve patient outcomes.  By increasing the Medicare population to 30% of the overall census, most FQHCs can make the same amount for preventive services as they do for their 330 Funding grant. At a minimum, FQHCs should look at increasing their Medicare population to the same percentage of older adults as live in the region, plus about 10% to 20%. In most regions, that would represent a goal of about 20% Medicare patients, with a stretch goal of 25% to 30%.  By developing a wellness team, Health Centers can increase the efficiency of their wellness programs and decrease the overall cost to perform these services (described here.)

More reliable revenues build sustainability, which strengthens programs,  allowing the CHC to better execute the mission of providing care to all ages at all income levels.

It is time that Community Health Centers reevaluate their approach to funding.  The way to do that is to look closely at Medicare patient recruitment and retention.  For FQHCs, the opportunity to make a difference in the Medicare population couldn’t be more important.  By developing a strong Medicare census, these organization serve the growing needs of older adults, strengthen and diversify their funding to build sustainability, and help to stem the nationwide costs of Medicare.  Additionally, by responding proactively CHCs can build their capacity, so they are better prepared to handle any new funding crises that may be on the horizon.