June 1, 2021

Advocates for Human Potential and PCDC: Q&A on Leveraging Funding from the American Rescue Plan

The American Rescue Plan has made unparalleled funding available for Federally Qualified Health Centers (FQHCs) and FQHC Look-Alikes (LALs). Primary Care Development Corporation (PCDC) and Advocates for Human Potential, Inc. (AHP) recently hosted a webinar to support FQHCs/LALs on how these new funding sources can be leveraged to set providers up for longstanding impact. The webinar reviewed the following funding opportunities:

The webinar recording, slides, and materials are available here.

As a follow-up to the webinar, Bonni Brownlee (Sr. Consultant, AHP), David Desai Ramirez (Western Market Leader, PCDC), Patrick Gauthier (Director, AHP), and Isaac Kastenbaum (VP, Training and Technical Assistance, PCDC) sat down with Jonathan Yan (Communications Manager, PCDC) to answer some questions about the incredible potential of this unprecedented funding opportunity to propel FQHCs and Look-Alikes forward on their broader strategic plans.

What do these newly available funds really mean for health centers?

Isaac: After more than a year of shutdown, rapid shifts to virtual care, massive strains on operations, and serious fiscal challenges, FQHCs and Look-Alikes have the financial capital to plan and invest rather than just react to crises. While the public health emergency is not over and the challenges of COVID-19 and vaccination efforts persist, leadership teams have more freedom to make the necessary operational, staffing, and programmatic changes necessary to ensure robust and resilient access and care going forward. 

Patrick: Simply and fundamentally, it means that community health centers can comprehensively address capacity for the first time in a generation or more. To the extent that capacity can be reflected in physical infrastructure, technology, workforce, and new care delivery methods, this is the time for leaders to step up, imagine and execute on the changes you want to see. If you need help, ask for it!

What are key areas that FQHC/Look-Alikes might consider for investment?

Patrick: If we are going to achieve equity in health care, we must ensure universal access. That means that physical infrastructure, workforce, and technology must be front and center. Does the community need more from your clinic in terms of space? Does your community need more from you in terms of a diverse and capable workforce?

Bonni: I would also add – Do your patients need greater access to behavioral health? Can you strengthen your integration efforts to meet community needs? Would your community benefit from better technology like tablets and access to Wi-Fi for telehealth?

David: Pivoting a little bit here to think about “how” you fund those investments, I’d like to encourage centers to talk to a CDFI or other financial consultant about your capital investment projects. Right now, there are so many financial resources available, many of which are grants or subsidies, and most of which FQHCs and Look-Alikes are eligible for. Even if something seems too complicated or time consuming, a conversation with someone who knows about these grant/subsidy programs can help you unpack and simplify the key questions and timelines, so you can decide how and whether to pursue which resources.

How can FQHC/Look-Alikes organize their planning needs?

Patrick: I think it requires honestly assessing your readiness and capabilities across business and clinical operations – soliciting the input of staff at all levels as well as the input of your customers and partners in care – and then bringing those assessments and ideas into strategic planning sessions. And if there were ever a time to devote attention to and prioritize these things, that time is now.

Isaac: In addition to setting aside time for planning (although difficult to do at times), health centers should also be cataloging their non-PPS revenue sources. These can include savings from Medicare Shared Savings Programs (MSSPs), health plan contract quality and total cost of care incentives, care coordination fees from Health Homes or Medicare Transitional Care Management, State-specific incentive programs (e.g., maintaining NCQA PCMH status), or grants revenue. Many of these programs – or the initiatives associated with them – may have been put on hold throughout the pandemic to reallocate staffing and resources. If there is an option to secure more reoccurring revenue sources (e.g., capitation, PMPMs, etc.) that are not dependent on encounters, this may be the opportunity to consider a transition to ensure continuity through any future business interruptions.

FQHCs are receiving capital dollars — what specifically should they be considering now?

David: Remember the power of leverage to advance your mission and key priorities. So many safety net healthcare stakeholders are seeing this as an important point in time when there are more capital resources available than usual to support medium and long-term investments in clinic infrastructure. We would encourage folks not to just cap themselves at the total HRSA capital grant amount, but to start first with the question “what are the priority investments I want to make now to advance our mission and increases our financial sustainability?” Viewed through that lens, there are numerous other financial resources (CDFI debt, New Market Tax Credits, HRSA loan guarantees, private grants…etc.) that can “add to the pot” to help you accomplish your investment goals in a perhaps even more financially sustainable way. There’s a lot of anecdotes in our space about the clinic that could spend $1M on renovations and increase patients visits by 10% (hypothetical) or spend $2M on renovations and increase patient visits by 35%, ending up in an even better financial position with the larger investment. We would never encourage folks to overextend financially, but often a little additional investment can go a long way towards accomplishing key organizational priorities.

Bonni: Several ideas come to mind here. Mobile clinic? Mobile hot spot? We know that health centers moved into telehealth services very quickly, without a lot of planning. The availability of capital dollars now could support the acquisition of a solid, secure telehealth technology platform. Some EHRs have this available as an add-on module. Or perhaps you need a different type of office space in the clinic to accommodate telehealth– small private “booths” instead of an exam room or office space, for example. Capital dollars could be used on remodeling/ reconfiguring space to support telehealth services in primary care, care management, etc.

How can PCDC and AHP specifically support FQHC/Look-Alikes at this time?

Isaac: Our teams can add extra capacity – analytic and content expertise, training, coaching, and just extra arms and legs for facilitating changes – wherever the organization needs it.

Whether it’s assessment, planning, execution, or workforce development, we can help. For some centers, the priority will be training. For others it might be workflow redesign followed by enhanced information management to support population health, while for others it might be all about standing up a new location. The assessment and planning efforts reveal what’s most important and we take our cues from your experiences. If planning a larger capital project, we can support a clinic on its funding strategy, helping you answer “how do I put it all together” – considering funding from the C8E program, New Market Tax Credits, CDFI loan capital, philanthropy, HRSA loan guarantees, or other sources.  As a CDFI, we are happy to talk to you when the project is in early concept phase and beyond.

Patrick: The greatest service and benefit we can provide you right now is perspective. Not only do we bring a national perspective, benefiting from many different places, provider types, systems of care, business models and the collective years of experience on a team as big as ours, but we are also able to deliver the perspective of folks who have hard-won experience in your shoes yet who, paradoxically, aren’t in your busy shoes right now.

The bottom-line is that we can help you make these most strategic decisions while simultaneously keeping your core values, aspirations, business model, workforce, patient experience, and unmet needs in the communities you serve in the clearest possible perspective.