Texas FQHC Joint Venture to Offer Services to Other FQHCs | Healthcare Innovation

Legacy Community Health Services, the largest Federally Qualified Health Center (FQHC) in Texas, has formed a joint venture with consulting and services firm Canton & Co., to provide infrastructure support to other FQHCs, enabling them to reach more of the underserved and increase their collective impact.

Houston-based Legacy and Baltimore-based Canton have formed Monarch Health Solutions, with an exclusive focus on community health centers (CHCs), including the nation’s nearly 1,400 FQHCs.

Legacy has more than 40 locations across Houston, Baytown, Deer Park, and Beaumont.

Its CEO, Katy Caldwell, said the new venture would be based on lessons Legacy learned as it grew over the years from a grant-supported organization to one that bills payers for its services. “At first, we didn’t know how to bill insurance or Medicaid or Medicare, and it was hard to find somebody to help us do that,” she said. “We limped along, but when we became an FQHC we still couldn’t find the resources to help us make that transition, to doing serious billing, and to manage everything that goes around it, including credentialing and privileging.” The organization grew gradually and learned lessons about managing the business side, and now  it is learning how to do value-based care, Caldwell added.

That is how Legacy connected with Don McDaniel, CEO of Canton & Co. “I’ve worked with FQHCs for a very long time, and met Katie about 10 years ago,” he said. “Historically there was this dichotomy that you couldn’t drive excellent community service and be a good operator in the FQHC space. You chose to be one or the other, right? And if you chose to be one, you sacrificed the other and vice versa. And what I found at Legacy was that Katie Caldwell has built a sophisticated organization that is committed to serving its mission. I wondered what the landscape would look like if more of the 1,400 FQHCs across the country could hit both of those objectives — could be really strong operators, and could continue to drive their mission.”

Among the services that Monarch plans to offer other FQHCs are:

• Comprehensive business strategy and planning services to improve performance and drive growth;

• Revenue cycle management (RCM) services to optimize coding, clinical documentation, charge capture, payer contracting;

• Actionable analytics and insights to support new patient acquisition, labor productivity, network decision-making, population health strategies;

• Managed services including outsourced RCM, virtual care management, IT management and departmental support for marketing, finance, recruiting and human resources; and

• Technology tools, experts, and resources to improve workflows and transform business delivery.

FQHCs have very specific needs that are not always met by traditional vendors and consultants, Caldwell said. “We’re in a different space in the primary care world than a for-profit  care system like VillageMD. I’m looking at our productivity standards for physicians vs. the productivity standards in some of the private practices. Our patients can take a lot longer. A lot of the revenue cycle folks, if they don’t know the FQHC world, they’ll question why the pediatrician only sees 20 people a day. They’ll say they are supposed to be seeing 50 patients a day. Also, Texas is a state that did not expand Medicaid, so we understand how to work in these non-expansion states, and a lot of consultants do not understand that.”

McDaniel said regulatory requirements and demands on FQHC providers are in some cases dramatically different than in commercial healthcare. “There are commercial firms that do drive-bys and fly-ins to try to support their needs, but they don’t really understand the nuances,” he said. The FQHCs can play a significant role in the shift to value-based care, with a focus on enhanced and integrated primary care, he added. “These FQHCs comprise 15 percent and sometimes as high as 30 percent of the primary care capacity in their market. This incredible group of assets has already been working for a long time on primary care with integrated behavioral health and integrated dental, and going to where the patients are.”

Most FCQHs are trying to figure out how to play in the value-based care arena, McDaniel said.  Who should they partner with? What should they be doing with payers? “There’s a lot of discussion in the FQHC world now about Medicare, because Medicare Advantage provides such a strong opportunity for an FQHC to become a really strong player in their market. Previously, many FQHCs haven’t had a focus on the the 65-plus population.”

Caldwell said the sweet spot for Monarch might be the mid-sized FQHC organizations that are ready to take a leap into the next phase of growth or are struggling to deal with negotiations with insurance plans.