FQHCs and Medical Homes

Federally qualified health centers serve a very important role in many communities that have few medical resources.  They provide inexpensive care.  Several years ago CMS began a three-year demonstration project to help turn the FQHCs into medical homes for Medicare beneficiaries, usually dual eligibles.  The Rand Corporation has issued a report evaluating the results of the demonstration.   (Rand Report)   The demonstration applied to 439 FQHCs and gave them an additional payment for each Medicare beneficiary, technical assistance in becoming a medical home, training and support and feedback reports.  This report was the second of three and assessed both the extent to which the FQHC demonstration sites had met the criteria for medical home status and the extent to which care processes and beneficiary outcomes improved.  To assess medical home status the NCQA criteria were used and Rand found that the sites made slow progress initially, but it picked up more toward the end of the demonstration.  By August 2014, there were 144 sites that had met none of the levels of medical home recognition and 208 that had achieved level 3, the highest, recognition.  Sites that had more revenue and more resources were more likely to work on medical home recognition and to receive higher qualification scores.

The researchers next looked at the effect of the demonstration on care processes and outcomes.  A big picture finding is that per beneficiary per quarter costs were higher in demonstration sites than comparison sites relative to differences at baseline.  The range of added costs was $61 to $101 per quarter.  From the demonstration sites perspective, it is unclear whether the additional revenue they might have received was sufficient to cover the costs of being a demonstration site.  There was significantly more utilization in the demonstration FQHCs, including more ER use.  But it could be that in these underserved communities, there was a lot of previously missed health care that was now being received.  A truly long-run analysis of cost and health trends would need to go for 5 to 10 years.  The demonstration sites did deliver more guideline-recommended care in some areas, such as diabetic blood and eye exams.  Somewhat surprisingly, the demonstration sites also showed a slight decrease in continuity of care compared to the control sites.  Beneficiary surveys on satisfaction showed no difference between the two groups.  So overall, a disappointing evaluation, but one sub-analysis that would be useful is whether the sites that did reach level 3 medical home recognition had better performance.