Federally Qualified Health Centers (FQHCs), known interchangeably as Community Health Centers (CHCs), are required, as part of their HRSA 330 grant funding, to increase the number of consumers they serve each year, including high-risk older adults. If a health center experiences a decrease in its service population, it can lose some or all of its grant funding. To prevent this, health centers must submit utilization data to HRSA each year, including the number of consumers served, the average number of times they received services, and their age distribution. Health centers that increase the volume of services provided to high-risk older adults are looked upon favorably in HRSA’s decisions to sustain or increase their 330 grant funding.
FQHCs also must increase the volume of insured consumers served by their center. High-risk older adults often have Medicare and Medicaid benefits that will allow for full compensation for health services rendered, including CDSME. Older adults who have two or more chronic conditions can be eligible for CDSME programs and have their participation reimbursed. As such, they are a potentially profitable target population that supports the recruitment and health care requirements of HRSA and contributes to the overall financial viability of the health center.
The Patient Protection and Affordable Care Act of 2010 encourages state Medicaid programs to develop medical homes and implement provider incentive payment programs for care to patients with chronic diseases. As a result, many FQHCs are becoming Patient-Centered Medical Homes (PCMHs), a primary care, team-based approach to meeting a patient’s health care needs. FQHCs are focusing on a PCMH approach with care that is:
- Committed to quality and safety
To achieve these goals, FQHCs are looking for ways to:
- Increase the volume of patients seen in the PCMH that receive care coordination
- Provide quality care at lower costs to patients, resulting in improved management of chronic conditions
- Improve patient activation in chronic disease self-management behaviors
FQHCs receive PCMH accreditation from organizations such as the National Committee for Quality Assurance (NCQA). They also can receive bonus payments from the Centers for Medicare and Medicaid Services and the Health Resources Services Administration for improving the quality and coordination of patient care leading to the management of chronic conditions. NCQA accreditation includes achieving the 6 PCMH standards:
- PCMH 1 Access and Continuity
- PCMH 2 Identify and Manage Patient Populations
- PCMH 3 Plan and Manage Care
- PCMH 4 Provide Self-Care Support and Community Resources
- PCMH 5 Track and Coordinate Care
- PCMH 6 Measure and Improve Performance
Chronic Disease Self-Management Education (CDSME) is proven effective in achieving several patient outcomes consistent with NCQA PCMH accreditation standards and Affordable Care Act legislation. Key outcomes of CDSME that align with NCQA PCMH accreditation standards include patient activation and improved management of chronic disease symptoms.