FQHCs face new challenges as COVID-19 keeps patients at home

The health care industry is transforming how it delivers care during the COVID-19 pandemic, and Federally Qualified Health Centers (FQHCs) are no exception. But the sudden inability to treat patients in an exam room or a shelter has caused new challenges. FQHCs are seeing a dramatic decrease in patient visits and billing, putting some centers at risk of closing. Should FQHCs continue to see a decline in their operations, this watershed moment could be devastating to care delivery for vulnerable populations across the nation.

Medicaid members are the cornerstone of FQHCs, making up nearly half of the patients seen. As preventative and primary care takes a back seat in the face of COVID-19, patient flow is dramatically decreasing, leaving some clinics struggling to keep the lights on. In many cases, they may only have 2–3 weeks of cash on hand, meaning an ongoing societal shutdown could have long-term, negative impacts on this part of the health care system.

The challenges of virtual care

Although telehealth platforms serve as one alternative for continuing to care for patients, they can pose operational challenges and financial limitations for FQHCs. Roughly half of these providers have never used virtual platforms, and those with experience have mainly used the platform to consult with specialists — not patients. Nearly overnight, these providers have had to learn how to provide virtual care. But with limited virtual waiting rooms and the inability to engage with more than one patient at a time, providers aren’t able to see as many patients as before. Providers have also struggled to find the proper codes for capturing their services, which complicates an already challenging process and significantly reduces clinic revenue.  Finally, many patients have not taken to the technology--so even when the FQHC has overcome all these hurdles, volumes are lower and they are not able to reach all who need care.

Many times, an FQHC’s electronic medical record (EMR) platform already has telehealth capabilities, so providers simply need training on how the system operates and how to properly bill their time.  In other instances, FQHCs need enhanced solutions to be able to connect with their members in their homes or other locations.  Transitioning to telehealth -- including maximizing the technology and engaging with members -- can require working with organizations, like Optum, that have experience with virtual platform infrastructure, telehealth systems, and navigating billing for virtual care.

In some cases, FQHCs are building on telehealth services by bringing care directly to patients in meaningful ways. For individuals facing homelessness in Washington, D.C., FQHCs are working to find safe, isolated alternatives to crowded shelters. In many markets, including Washington, D.C., FQHCs are partnering with health plans and other organizations to create capacity to provide services like medical respite in hotels.  For instance, in Washington, D.C. hotels  are dedicated to housing vulnerable individuals and offering safe isolation for individuals who test positive for the virus. With increased risk due to COVID-19, it is important that vulnerable populations have access to resources that can keep them well during the pandemic.

Anticipating the growth in Medicaid enrollment

Given the recent increase in unemployment rates, we expect to see Medicaid enrollment spike in the coming months. And if the capacity of FQHCs shrinks during that same timeframe, these enrollees will be forced to seek out other providers, many of which may not have the availability of services needed to care for them. This could also make getting care more difficult for low-income individuals and those who are uninsured, putting them at even more risk.

To stay afloat during this time, some FQHCs have qualified for relief bills and other financial support. In the coming weeks, a new Congressional bill worth $75 billion will be distributed to hospitals and eligible providers, including FQHCs. But with no end to COVID-19 in sight, it is impossible to say how far this relief money will need to be stretched.

Collaborating for the future

UnitedHealthcare is working with its FQHC Advisory Board and FQHC partners nationally to identify areas to deploy assets and expertise to support this vital part of the country's delivery system.  Each community has its own unique needs as do FQHCs and we believe this will require an individualized approach to ensuring FQHCs are available to meet the demands of patients who rely upon them.

As COVID-19 lingers, FQHCs will play an important role in addressing disparities where mortality continues to be a threat. New collaborations across the health care industry will be required to create sustainability for FQHCs-- and thereby help address the health needs of our most vulnerable populations amidst and after this crisis.

Read more from Catherine Anderson and Dr. Stephen Cha


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