Why is strategic planning key to FQHC success in our current health care landscape?
Strategic planning has long been a cornerstone of success for Federally Qualified Health Centers (FQHCs) and a mandate of the Centers for Medicare and Medicaid Services (CMS). At its core, a strategic plan provides a structured framework for evaluating the current landscape, and defining our assumptions about the future, with relation to any new opportunities, market changes or potential business risks. A strong strategic plan requires a robust planning process, structured to guide FQHC leadership in identifying opportunities that align with the organization’s long-term vision and will enable the organization to respond proactively (or prepare for) to changes in policy, new opportunities and changing community needs.
As CMS increasingly shifts to promoting value-based payment (VBP) models, aligning strategic priorities with this approach will be an essential component of FQHC strategic plans that are successful in the current market and sustainable into the next decade.

How do FQHCs optimize their strategic planning process?
Strategic plans that are misaligned with organizational mission, vision and values or that lack actionable & measurable goals run the risk of “sitting on the shelf.” To avoid this as the outcome of what can be a resource-intensive process, there are several best practices that FQHCs can follow:

1. Conduct a comprehensive assessment of the FQHC’s market position, community demographics and create informed assumptions regarding local, state and federal regulatory or market changes.
2. Engage in visioning exercises to define what success looks like over the next 5 to 10 years. Whether it’s expanding into new services, reaching new patient populations, creating deeper engagement with managed care plans, or integrating more robust care coordination models, this visioning process ensures that strategic planning is not just reactive, but forward-looking and responsive to our assumptions about the future.
3. Conduct a gap analysis to compare the current state with the desired future state to identify capabilities, resources and partnerships that need to be developed to achieve the long-term vision.

   The output of these activities should be a market-informed and actionable strategic roadmap. Ideally, this strategic roadmap should be treated as a living document to encourage continuous alignment with the organizational mission & vision, while allowing for course correction to the local healthcare landscape or regulatory environment. Establishing clear value propositions to key stakeholders (e.g., patients, community providers, health systems and managed care plans) in this process can help position FQHCs for future success and ensure the plan is comprehensive in nature. Stakeholder value propositions help shape requirements & strategic initiatives, while the planning process increases engagement & relationship building.

How can VBP be effectively incorporated into a strategic roadmap?
FQHCs are uniquely positioned to succeed within VBP models and should be especially attuned to these opportunities as they engage in their strategic planning process. Compliance with CMS’ requirements to retain FQHC status necessarily means these organizations are engaged in population health management activities that align with VBP models, including care coordination, disease management and quality improvement. These capabilities provide a natural foundation for participation in a range of VBP arrangements and demonstrate the organization as a strong quality partner to managed care plans. By aligning incentives with outcomes, VBP models can reward FQHCs for delivering high-quality care and total cost of care improvements, depending on the VBP arrangements in which it participates.

Though FQHCs are often the well positioned organizations to pursue these types of arrangements, they can also be among the most hesitant to engage in more mature VBP models. One key piece of misinformation it is important to dispel is that engaging in a VBP arrangement impacts an FQHCs prospective payment system (PPS) rate or wrap payments. In fact, VBP complements the wraparound payment structure that FQHCs rely on. VBP contracts and wraparound payments from CMS work in tandem with each serving a distinct but complementary purpose in supporting FQHC sustainability and care quality:

• Wrap (around) payments are designed to ensure FQHCs receive a minimum level of reimbursement for services provided to Medicaid patients, regardless of what a given managed care plan (MCP) is willing to pay. The payments “wrap around” the MCP payment to bring total reimbursement up to the PPS rate, which reflects the cost of comprehensive care of the FQHC.
• VBP arrangements offer additional upside incentives based on performance metrics such as patient outcomes and quality. These incentive payments layer on top of the wraparound payments, meaning FQHCs can continue to receive their guaranteed PPS-level reimbursement while also earning bonuses or shared savings from MCPs.

This “dual-revenue” model allows FQHCs to:

• Maintain financial stability through wrap payments
• Pursue care transformation (i.e., invest in infrastructure, staff, expand service lines, etc.) with VBP incentive dollars
• Strengthen partnerships with MCPs/payors and partner health systems

Engaging a trusted advisory with deep expertise in strategic planning and VBP models can help FQHC boards and leadership teams effectively evaluate and prioritize the ones that best suit their organization’s strategy and position in the market. Value-based enablement firms, like COPE Health Solutions, have a breadth of market knowledge and experience, which FQHCs can lean on to educate their strategic planning committees, model out various growth, service line or VBP arrangements to determine what options best align with the organizational strategy.

To be successful in a VBP focused Strategic Planning process
Strategic planning presents an opportunity to evaluate and strengthen MCP partnerships. FQHCs can take this time to assess whether their current MCP partners offer meaningful opportunities for shared savings, infrastructure investment and quality incentives. FQHCs can also opt to directly participate in CMS programs like Medicare Shared Savings Program (MSSP) or become a participating provider in an Independent Physician Associations (IPAs) to access VBP contracts and quality dollars. To be successful in incorporating these opportunities into a strategic planning process, FQHCs should prioritize the following:

1. Engaging the Board of Directors (especially supporting in education & gaining buy-in)
2. Collect input from management and frontline staff that may impact the organization’s ability to deliver against certain VBP requirements
3. Clearly define approach to partnership, mutual value, roles & operational requirements (ex.: appropriate access to data, engagement of appropriate team members)
4. Assessing existing technology and operational efficiency to enable success under any VBP arrangements

Incorporating scenario planning and “what-if” exercises into the strategic refresh process is one method for FQHCs to map out and assess viability of the different VBP options in their market. These types of activities can also help to engage leadership, frontline staff and community members/organizations in conversations about VBP to ensure these key stakeholders are educated on the principles and aligned with the implications of this type of arrangement on their roles and experiences. Additionally, this process can help surface stakeholder misconceptions about VBP and further inform resources that will need to be considered to effectively roll out VBP initiatives.

By incorporating VBP models into strategic planning discussions, FQHCs can produce a roadmap that takes advantage of present opportunities and positions them for success across multiple lines of business, with increased diversity in revenue sources and broader patient base.

How CHS can support your Strategic Planning
CHS’ has supported FQHCs across the country in their strategic planning initiatives with the primary aim of ensuring relevance, responsiveness, and long-term impact of the strategic outputs. In the current health care landscape, this has included a significant focus on incorporating population health management principles and VBP oriented goals into the organization’s vision and strategic roadmap. The team at CHS is well-prepared to guide your organization through the steps necessary to plan for and realize these goals.

Contact us at info@copehealthsolutions.com and speak with us of the issues you face in your FQHC.