Federally Qualified Health Center Payment Reform

Federally Qualified Health Center (FQHC) Payment Is Changing

As part of the Department’s efforts to shift providers from volume to value, the Department, along with stakeholders, has developed a payment model to make differential payments based on the provider’s performance. This payment model aims to give providers greater flexibility in care provided, reward performance, and maintain transparency and accountability in payments made. Under the proposed model, a portion of the Federally Qualified Health Center's Alternative Payment Methodology (APM) cost-based rates will be tied to quality activities and performance metrics.  Progress within this framework not only encourages higher organizational performance but also helps the Accountable Care Collaborative (ACC) achieve its respective programmatic goals.

 

Implementation of the Alternative Payment Model (APM) for participating practices:

  • The 2019 performance year will be evaluated and incentive payments will be issued based on each practice’s reporting for structural measures and eCQMs only. This means that every practice that selects measures and properly reports progress on those measures will earn full credit.  FQHCs will still be evaluated on their performance for claims based measures.
  • Practices should select APM measures in November and December 2018 in order to properly report progress or challenge areas identified during the 2019 performance year.

  • Measure Selection Survey 

 

Value-Based APM Goal
  1.   Provide long-term, sustainable investments into primary care; 
  2.   Reward performance and introduce accountability for outcomes and access to care while granting flexibility of choice to PCMPs, and; 
  3.   Align with other payment reforms across the delivery system.

FQHC Value-Based Primary Care Alternative Payment Model Measure Survey

The initial measure selection survey for the 2019 performance year is closed. The Department will be sending confirmation emails to the contacts provided in the survey. FQHCs will have the option to change the measures they selected for 2019 towards the end of 2018.  If you have questions about the FQHC APM please contact Marija Weeden at marija@cchn.org. For information regarding the non-FQHC primary care APM, please find additional resources here.

FQHC Survival Guide * Updated February 2019

 
For information on the Implementation workgroups that created the initial APM, please visit the Primary Care Payment Reform