Post-pandemic, FQHCs will have to learn to make telehealth sustainable, leverage new funding opportunities and partner to adapt to the new normal.
- Jennifer Genua-McDaniel: CEO and Founder of Genua Consulting
- Jay Jolly: CEO of La Familia Medical Center in Sante Fe, New Mexico
- Jordana Powell: President and CEO of the Illinois Primary Health Care Association
There’s no doubt that COVID-19 shook the world. For community health centers (CHCs or FQHCs), the increased vulnerability of their patients, paired with unstable funding may have them looking for an answer of where to go next in a time of uncertainty.
During Advanced Medical Partner’s Webinar, entitled “The Path Forward for FQHCs,” speakers from across the community health center space spoke about how centers can start to take action to plan for a hopeful future. Here are a few considerations they shared.
Understanding the New Normal
It’s likely that policies and workflows will never fully return to what they were pre-Coronavirus Disease 2019. Various policy changes have been enacted, forcing FQHCs to change the way they practice. FQHCs should consider how they will protect staff from burnout, while still being able to provide quality care. But they don’t have to plan for their future alone. Both Genua and Powell said that coming together and working together will prove to be most effective during this time. Powell said for FQHCs in Illinois, he wants them to know that they are not alone and that the Illinois Primary Care Association (IPHCA) is backing them. He believes the same applies for FQHCs of other states.
“If you try to go at it alone, you’re going to have some blind spots and you’re going to miss something,” Powell said.
Powell said that PCAs provide numerous resources which FQHCs should be able to access with ease. Their job is to curate these resources and put them in an easy-to-understand format. Powell and the IPHCA are even helping FQHCs who are not dues-paying members during this time, because he believes the most important thing is helping FQHCs help their communities.
The next step, Genua said, is ensuring health centers are financially viable.
No Money No Mission
Unstable funding has long been a concern for FQHCs, and now the worry is only heightened.
“CHCs have existed and been extremely resilient for more than 50 years,” Powell said. This time is no different. First, FQHCs should make sure they have exhausted all possible resources before taking any drastic action. The health centers should look into any government funds available to them, because, as Powell said, this pandemic has proved just how valuable CHCs are. The IPHCA has put together a document that lists possible sources of funding; other PCAs may be able to do the same. Powell’s advice for advocating for long-term funding is to go to the governments with a solution, rather than just a problem.
However, Jay Jolly argued that statewide organizations may be able to help FQHCs with funding the most. He also advised FQHCs to work together to see how they may be able to divide different services between each other, rather than doing all services all by themselves.
“There’s so many themes that keep recurring anytime we’re facing an uncertain future and one of them is collaboration,” Jolly said. “Communities need to come together. If we think about ourselves as an individual entity, you limit your resources.”
So for FQHCs who may not be receiving the individual funding they would like, Powell urged that some will have to make difficult decisions. This may include looking at a merger between FQHCs, taking pay cuts to keep all members of the staff on the team, or cross-training staff to do a variety of tasks (e.g. a nurse simultaneously performing front-desk duties).
A huge financial pain point health centers have seen is purchasing personal protective equipment (PPE), especially as they prepare to accept more patients. Powell said that one issue for them was not being used to vetting suppliers. In order to not waste resources, health centers must be careful of fraudulent sales coming from overseas. Many PPE advertised may not actually be medical grade.
Genua also warned of noting the difference between N95 and KN95 masks, the latter of which physicians should change more frequently, which means it needs to be purchased in larger quantities. Being informed will help health centers stay prepared, Genua said. Health centers must also be aware of the fact that a lot of PPE coming from overseas is going through customs and being spearheaded to the national stockpile, which is why health centers are not receiving as many.
Jolly said by maintaining half a dozen suppliers, his health center has been able to slowly build up inventory, albeit a little more expensive. In times of need, Jolly also recommends relying on homemade masks supplied by the local community to give to patients in waiting areas when possible.
FQHCs Prepare to Reopen, While Making Telehealth Sustainable
Jolly said with recent policy changes, telehealth has proven its value and is here to stay. He said telehealth does a great job at addressing the fear people have of going out in public, as well as the issue of mobility for elderly patients. Through the use of telehealth, Jolly said, clinicians can see more patients and save in-person visits for situations that really need them. Genua and Powell provided a sample model for an FQHC where Monday-Thursday are reserved for telehealth visits, with Friday being a day designated for well visits in the morning and sick visits in the afternoon.
Now, it’s time for FQHCs to lobby for recently introduced reimbursement policies to stay in effect, Powell said.
The cat is out of the bag when it comes to telehealth!
“The cat is out of the bag,” Powell said. “I’m getting tired of people talking about telehealth in the short term. It’s going to be hard for payers to roll it back. In Illinois, we’re not preparing for it to roll back, we’re preparing to fight for it to stay.”
Jolly said in order to do this, FQHCs need to showcase how telehealth can provide the same quality of service, with some added benefits. Genua added this could mean leveraging data to show off higher quality indicators
“Demonstrate value and then lobby for reimbursement for the same parity as in person.” Jolly said. “If you’re getting the same value, it should be the same.”
Now is the time to pilot and be innovative, Genua would agree. When it comes to reopening face-to-face visits, consider how the traditional brick and mortar space might look different. She said consider looking at home visits, drive-throughs and mobile health centers.
Examining the current social and health needs of patients is critical, as well. For example, Genua saw PTSD go up in her patient population, so they’re working more on behavioral health initiatives. In Santa Fe, immigrants comprise a large portion of Jolly’s patient population. The patients are not coming in, because they are afraid of being traced by ICE. FQHCs should think more about what might affect retention in the coming weeks.
Powell said, if anything, the pandemic has pressed the fast forward button on resolving the many shortcomings of the health care system that FQHCs have been shouting for years.
“It’s too early to tell if it’s going to change things forever, but it did expose things we’ve been arguing for forever.” Powell said.