Health

Community health centers are looking for ways to capture revenue

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The last decade has led to a rapid and necessary expansion of community health centers fueled in large part by billions in grant funding provided through the Affordable Care Act.

But the program has also been a constant source of concern for these providers. The Community Health Center Fund, created in 2010, counts 70% of federal support. So, every year, CHC providers hold their collective breath, waiting to see if Congress will re-authorize the Fund.

“When you’re constantly nervous about funding cycles it’s hard to plan strategies and do innovative things over a two-year, three-year period,” said Janet Vadakkumcherry, associate vice president of managed care for Health Centers. Partners from Southern California, home to a network of community health centers that serve patients in the San Diego, Riverside and Imperial regions.

These concerns have prompted more CHCs to diversify their revenue streams. Larger community health centers like HCP are finding ways to increase their reimbursement from public and commercial insurers.

The pandemic has not been easy in CHCs, which have reported a 43% drop in patient visits over the past year according to a brief study by the Kaiser Family Foundation. More than 1,900 health center sites have been temporarily closed since May 2020, the report found.

Amanda Simons, interim chief executive of Integrated Health Partners, HCP’s clinically integrated FQHC health network, said 99% of IHP revenue comes from MediCal, California’s Medicaid program.

To capture more of this population, HCP will begin targeting older adults with programs such as home health services. The goal is to make community health centers draw on a wider patient base.

“We just have to be aggressive,” Simons said. “I think the FQHCs haven’t historically told their story well enough.”

Simons said IHP and HCP have large learning networks to help providers of operational problems including coding, clinical documentation and income cycle management, as many smaller community health centers lack these resources and competence.

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This need has encouraged other large CHC operators to serve as peer consultants.

“Over the years we’ve received a lot of calls from people asking us to help them with their turnover, their revenue cycle, their marketing, or to tell them how we’ve grown,” said Katy Caldwell, CEO of Houston Community Health Center, Legacy Community Health. “So we want to see if we can really bring some good services and value-added services to other qualified federal health centers across the country.”

Legacy recently joined health consulting firm Canton & Company to form Monarch Health Solutions, to market business solutions only to community health centers looking to scale their financial operations.

Monarch offers services such as business planning, revenue cycle management capabilities, and strategies around new patient acquisition, payroll contracting, and population health management.

Caldwell said Monarch came from the Legacy evolution from an HIV clinic in the 1980s to a Federal Qualified Health Center today, providing care for more than 189,000 patients at 41 sites annually.

“One of the things we went through going from a fully licensed organization to one that was going to bill Medicare and Medicaid and private insurance was learning how to bill,” Caldwell said. “We had difficulty finding people who were in our position or counselors who understood aid funding and billing in an FQHC world.”

According to KFF, 61% of CHC patients earn incomes that are below 100% of the federal poverty line, and 69% are uninsured or on Medicaid.

Don McDaniel, CEO of Canton & Company, said he saw Legacy’s experience in growing its operations as a model that other community health centers could adopt. He felt Legacy as a partner added a layer of credibility and confidence to the quality of services that Monarch offers. But McDaniel felt another vital aspect of the joint venture was the prospect of a community health center operator on the types of administrative and financial support that those providers might need most during each phase of their growth.

“We think we have a great advantage that we have a basin of sand and a strong team that can really help us think about the right way to do it,” McDaniel said.


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