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Ryan White and ACA: Laying the FQHC Groundwork

February 6, 2014


Becoming a Federally Qualified Health Center (FQHC) is a journey. We have been tracking the progress of a Ryan White recipient as it pursued designation as an FQHC and the tips and tools they created and adopted along the way.

So Far on the Journey

To recap, Catawba Care’s initial steps included securing board review and approval of the plan to pursue FQHC status and an early needs assessment to solidify insights on the need for a Health Center in the service area. This brings us today to 3 crucial steps, being taken somewhat simultaneously.

“We are constantly working on this. We’ve just finished a revised strategic plan that includes one goal [of two] focused on our FQHC plans. We are [also] meeting with partners to outline strategic collaborations.”

1. Meetings with Stakeholders and Strategic Partners

Primary care and specialty providers. Hospital directors. Prospective funders. Elected officials. These are potential partners and people you need to meet with when planning an FQHC strategy.

According to Executive Director Anita Case, meeting with health providers in the service area is crucial because, “We will need a lot of partners to support us in providing services, including discounted services, to future Health Center patients.” That’s manageable for Catawba now, as a smaller Ryan White clinic, but not if it expands to take on a larger population of clients.

Examples of critical connections range from a hospital to provide discounted care to a cardiologist who will take sliding fee payments for Health Center patients. Without that, patients in search of specialty care would leave the clinic with little more than a referral slip for care that would be unaffordable.

Clients with Affordable Care Act marketplace coverage likely won’t face that challenge, but South Carolina is not expanding Medicaid eligibility, leaving uninsured clients without meaningful options.

Scripting Conversations with Partners

How does one prepare for meetings with stakeholders and potential partners? According to Case, a script is not necessary but, rather, an open agenda for sharing ideas about the clinic’s plans and an expressed desire that you are seeking community support. However, “We’re not asking for money right now rather sharing our plans and potential needs for future funding, and getting advice, including how to approach potential funders.”

“It depends on who I’m meeting with,” says Case, who always seeks out advice. “People like to be asked for advice. Also, you can learn a lot from different perspectives. With funders, definitely ask for advice, like how to present information when soliciting funding support.”

As for meetings with medical providers, “Talk with them about the value [the clinic] would bring to the community, demonstrated by improved health outcomes. It’s not just 'give us, give us.' Health Centers help keep people out of the ER and, ideally, give people a medical home,” says Case. Summing it up, she works to “help people understand the win-win—how will we both win and how patients will win.”

2. Keeping Clients—and Staff—in the Loop

Consumer involvement is central to Health Centers and to the Ryan White program itself, so it is no surprise that keeping consumers informed about potential change is part of Catawba Care’s plan. Two client forums were held in January 2014 to explain the Health Center concept and what it might mean for changes in care.

These forums, Transitioning to Become a Health Center, are being backed up in a handout that will be available for all clients, including those unable to come to the community meeting. Staff talking points also have been prepared to ensure that the same message is going out through all channels.

Speaking of staff, Catawba held a briefing session in December 2013, addressing topics such as fear of change and jobs. Importantly, the board members were present to field questions.

3. A Plan and a Timeline for Change

Catawba, like any smart agency, has developed a two-goal Strategic Plan to guide its work in the coming year. One goal is focused on continuing and strengthening HIV services, the other on transitioning to community health as a Health Center. “It’s not rocket science but is a good roadmap for our process,” says Case.

Within the plan are some notable benchmarks for the clinic. One is a tentative plan to add a physician in Summer 2014, who will support current HIV programming while beginning some type of expansion of the patient population into general primary care. The plan to expand into general primary care is crucial to gaining FQHC designation, as being a Health Center “look-alike” status, which requires a clinic to have demonstrated at least 6 months of primary care services to patients.

It’s not certain how expansion of the clinic’s census will be approached. Options include taking on family members of current patients, STD patients without primary medical care, or even the first 50 people who come in the door. “We’re planning a slow start, hoping that we can gradually expand our patient population in the second half of 2014—and we are waiting for the [HRSA FQHC New Access Point] funding opportunity announcement to come out," Case says.

“I do something with it every week. It’s not sitting on the shelf working itself out.”

Other matters to be worked out include determining what changes to the board need to be made, what changes in transitioning to non-HIV care are necessary (e.g., whether status can be granted to clinics that currently provide only HIV care, even if they are compliant with other look-alike requirements like board composition and having a sliding fee scale in place). Catawba will be asking its state Primary Care Association for advice on such issues.

Money is definitely an object. Says Case, “Our funding is very much tied to HIV, including 340B, so we can only do so much without additional funding or Health Center status. Our strategic plan is the guide for securing funds so we can achieve look-alike status. Once we have that, 340B funding can be used for all our patients.”

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