Lessons from Tracy Douglas, CEO of Virginia Community Healthcare Association, on innovation for Federally Qualified Health Centers
This episode is part of Pear VC's series on Medicaid, covering the basics that founders need to know to build innovations that support communities in need.
Welcome back to the Pear Healthcare Playbook! Every week, we’ll be getting to know trailblazing healthcare leaders and diving into building a digital health business from 0 to 1.
This series aims to demystify Medicaid, starting with insights from federal and state agencies, FQHCs, and managed care organizations, before exploring successful founders' strategies. Read our primers on the key players and innovations here, and stay tuned for upcoming posts featuring interviews with key opinion leaders, purchasers, and startup founders.
Today, we're delighted to introduce Tracy Douglas, the CEO of Virginia Community Healthcare Association (VCHA), which is the primary care association representing Virginia’s Federally Qualified Health Centers (FQHCs) .Â
Tracy brings over 25 years of healthcare administration and operations experience. She has held executive roles in FQHCs in Indiana and Maryland, overseeing multiple locations across both states. In these roles, she led operations, maintained financial strength, and supported strategic goals to achieve excellence in medical practices, programs, and services. Tracy has managed operations in various healthcare settings, including pediatric centers of excellence, providing cardiac, kidney, and pulmonary services, both clinic-based and surgical. She also oversaw outpatient and inpatient acute care services and led a large health system’s managed care division. Additionally, Tracy served as the Executive Director of a for-profit physician-hospital organization.
In her current role, Tracy is responsible for the overall operation, management, program development, and fiscal control of VCHA. She also advocates for the Association’s members with federal, state, and local policymakers to ensure they have the tools and resources needed to improve access to primary care for the underserved in Virginia.
Tracy received her bachelor’s degree from the University of Maryland, College Park, and her master’s degree in General Administration with a focus on Healthcare Administration from the University of Maryland University College.
In this episode, we learn about the scope of FQHC services, how FQHCs are financed, what challenges they face and how they evaluate vendors.
We encourage you to listen to our podcast episode where we dive deep into all of the following sections.
Early Career and Experience
Tracy has devoted the majority of her career to healthcare administration, beginning in hospital systems in the DMV area. She collaborated with a variety of stakeholders, including legislators, providers, and Medicaid directors, gaining insights into various aspects of the healthcare system.
Tracy currently serves as the CEO of the Virginia Community Healthcare Association (VCHA), a membership organization consisting of nearly 30 FQHCs and Look-Alikes (LALs). The VCHA, designated by the federal government to support the health center movement, benefits from Tracy's experience as she works to ensure the sustainability of these health centers.
FQHCs Role in Medicaid
Federally Qualified Health Centers (FQHCs) and Look-Alikes (LALs) have served communities for over 50 years. They provide comprehensive primary and preventive care to underserved communities, and are significant Medicaid providers. LALs typically don't receive federal funding, and their malpractice insurance isn't covered by the federal government. However, they cater to similar populations. They often serve as a crucial access point for many beneficiaries. Nearly 15,000 FQHCs and LALs serve 1 in every 11 Americans across the country.
FQHCs often serve uninsured, underinsured, or low-income individuals. Unlike private practitioners, they are obligated to provide a variety of services beyond primary care, regardless of a patient's ability to pay. They employ different providers to offer additional services such as dental care, mental health support, case management, and more. Some FQHCs even operate their own food pantries. They also assist patients in acquiring insurance if they lack coverage.
FQHC Certification
To become an FQHC, an organization must serve a high need community, have a community board with at least 51% patient representation, provide comprehensive healthcare services on a sliding fee scale. [Source] They are non-profit organizations or public entities.
Health centers must also undergo an application process. This occurs when the federal government, specifically HRSA, initiates new access points or service area competitions. The government identifies underserved areas and establishes a competition for health centers. This grants access to federal funding and malpractice coverage from the government. In Virginia, there are 28 FQHCs and one look-alike center, spread across nearly 200 locations.
FQHC Funding Sources
FQHCs are sustained by a "three-legged stool" of federal grants, billing revenue, and 340B pharmacy revenue. While the majority of FQHCs operate their own pharmacies, some establish contracts with larger pharmacy chains like CVS or smaller, locally-owned pharmacies.
In addition to these core sources, FQHCs also actively pursue grants tailored to specific programs or initiatives. For example, with the current focus of the Biden administration on maternal and child health, there are numerous funding opportunities available to FQHCs in this sector.
The overarching objective is to maintain a diverse portfolio of funding sources to safeguard the sustainability of these health centers. This necessitates diligent application for, management of, and keeping abreast with all the available funding sources.
FQHC Operations and Challenges
Operating Federally Qualified Health Centers (FQHCs) can be challenging due to their commitment to provide mandated services, meet federal compliance, and adhere to reporting requirements.Â
These centers place a strong emphasis on internal quality monitoring and assessment to deliver high-quality care under close scrutiny. FQHCs often have quality committees composed of clinicians and administrators who monitor and manage the quality of care.
Community health centers need a separate Medicare agreement for service reimbursement and must adhere to the Civil Rights Act of 1964, prohibiting discrimination. They must meet mission-based standards demonstrating service to the target population, with clearly defined populations and services without overlap. Centers must also be governed by an elected board, following rules for financial management, billing, and board composition. [Source]
Consistent non-compliance may result in a health center only receiving a 1-year project period or HRSA not renewing their designation. This can lead to loss of access to federal grant funding.
Technology Opportunities for FQHCs
FQHCs continuously gather data to enhance their operations. However, they often need support to effectively navigate and utilize this data. Technology could improve FQHCs' capacity to gather and analyze data, particularly social determinants of health data from sources outside the health center. This could provide valuable insights for clinical decisions and resource allocation.
For instance, it's crucial to incorporate social determinants of health data into the rest of their data. This allows them to leverage this information to guide clinical decision making. The right question a digital health company can help answer is: How can we use this information to assist the FQHC in caring for the member? This approach brings us one step closer to personalized medicine.
Evaluating New Technology
VCHA member health centers utilize Group Purchasing Organizations (GPOs) to streamline operations . Through GPO agreements, VCHA contracts with vendors to offer cost savings and/or shared services to members. As non-profit entities, health centers often operate with tight budgets and are sensitive to price. Any savings are reinvested back into their organizations.
When selecting vendors, VCHA outlines requirements based on the intended use case. They evaluate factors such as features, pricing, and ability to meet needs. Both clinicians and administrators vet these options.
Successful Health Center Partnerships
VCHA has partnered with i2i Population Health, a technology vendor. Together, they have created a data warehouse that consolidates real-time data from health centers' EMRs, labs, and insurers. This collaboration provides health centers with a more comprehensive view of their patients' data.
Opportunities and Obstacles for Medicaid
Medicaid is a partnership between the federal and state government. During COVID, Medicaid enrollment surged while states relaxed eligibility requirements. After the pandemic, the COVID protections lapsed leading states to reassess eligibility. Many members were unaware that they were responsible for reapplying for Medicaid which resulted in some patients losing coverage. However, FQHCs have systems in place to continue serving these patients. One opportunity for Medicaid is to simplify the process of re-determining eligibility.
There is an increasing emphasis on linking Medicaid reimbursement to the quality of care and health outcomes. In Virginia, health plans will soon be contractually obligated to ensure certain quality measures are met. For providers, technology that captures data on social determinants of health will be crucial to demonstrate quality.
Opportunities for Builders
Collaborate with FQHCs to support their clinical workflows and assist with patient care outside the clinic setting.
Aid FQHCs in generating additional revenue through expanding their patient base and securing grants.
Assist FQHCs in augmenting their data with SDOH data, and then create actionable interventions that effectively improve care using this data.
Interested in VCHA? Learn more on their website and their Linkedin.
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