The Playbook

As a best practice, hospitals, public health and mental health should have a federally qualified health center (FQHC) partner. Within constraints of anti-trust laws concerning primary care, chronic care and mental health services, hospitals and FQHCs should work together to get patients into medical homes and out of hospital emergency rooms (ERs).

The economic impact of community health centers is approximately $250 million annually, including:

• Physician impact of local economies
• Overall CHC workforce (1,800 employees)
• Tax base
• CHCs serve more than 300,000 Mississippians

Health centers and Medicaid work together to provide coverage and access for some ofthe most vulnerable Americans. Health centers are the health care home for more than 25 million patients, 49% of whom are covered by Medicaid. Nationally, health centers care for more than 1 in 6 of all Medicaid beneficiaries.

Health centers save the Medicaid program $6 billion annually and an estimated $216,786,500 in Mississippi and health center patients with Medicaid have lower utilization of costly hospital and emergency department-related services compared to patients at other providers. A recent landmark study of 13 states found that health centers save Medicaid, on average, $2,371 (or 24%) per year in total cost of care when compared to other providers.

Congress recognized the vital role of health centers within Medicaid by creating a unique prospective payment system that ensures predictability and stability for every health center while saving Medicaid money overall. Even without any reduction to Medicaid benefits and eligibility, eliminating this payment system alone would result in a loss of roughly 30% of health centers’ Medicaid revenue nationwide – for many health centers, the figure could be even higher.

In 2018, CHCs have approximately 17,000 atttributed Medicare lives and saved the Center for Medicaid Services (CMS) $6,472,274. Mississippi CHCs serve more than 95,000 Medicaid beneficiaries, which is 31% of all patients served by health centers. Health centers are also cost-effective Medicaid providers, serving 13% of all Medicaid beneficiaries in our state but representing less than one percent of the state’s total Medicaid expenditures. 

Quality Scores among FQHC participating in Accountable Care Organizations (ACOs) exceed benchmarks and validate more accountable care: lower, cost-improved quality.