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Objectives: To describe the Health Resources and Services Administration's Quality Improvement Award (QIA) program, award patterns, and early lessons learned. Study Setting: 1413 health centers were eligible for QIA from 2014 to 2018. Study Design: We assessed cumulative QIA funding earned and modified funding excluding payments for per-patient bonuses, electronic health record (EHR) use, patient-centered medical home (PCMH) accreditation, and health information technology. We compared health centers on rural/urban location, PCMH accreditation, EHR reporting, and size. Data Collection: Organizational and quality measures are reported in the Uniform Data System, QIA program data. Principal Findings: Average cumulative funding was higher for health centers that were not rural (USD 380,387 [[+ or -] USD 233,467] vs. USD 303,526 [[+ or -] USD 164,272]), had PCMH accreditation (USD 401,675 [[+ or -] USD 218,246] vs. USD 250,784 [[+ or -] USD 144,404]), used their EHR for quality reporting (USD 374,214 ([+ or -] USD 222,866) vs. USD 331,150 ([+ or -] USD 198,689)), and were large (USD 435,473 ([+ or -] USD 238,193) vs. USD 270,681 ([+ or -] USD 114,484) an USD 231,917 ([+ or -] USD 97,847) for small and medium centers, respectively). There were similar patterns, with smaller differences, for average modified payments. Conclusions: QIA is an important feasible initiative to introduce value-based payment principles to health centers. Early lessons for program design include announcing award criteria in advance and focusing on a smaller number of priority targets. KEYWORDS equity, federally qualified health center, health disparities, pay for performance, quality improvement, safety net, value-based payment What is known on this topic * Value-based care has gained traction in the US over the last decade, but implementation of programs specifically designed for safety net settings has been limited. * The Quality Improvement Award (QIA) program began in 2014 as the first program of its kind to introduce value-based payment to federally funded health centers. What this study adds * The early QIA experience demonstrated the feasibility of introducing value-based payment principles into the safety net. * Health centers that were not rural, had patient-centered medical home accreditation, used their electronic health record for quality reporting, and were large received higher average QIA funding than their comparison groups. * Announcing award criteria in advance and focusing the financial incentives on a smaller number of high priority targets may strengthen the program's quality incentives., 1 | INTRODUCTION The Quality Improvement Awards (QIA), started by the Health Resources and Services Administration (HRSA) in 2014, was the first program to financially reward HRSA-funded federally qualified health [...]

Objectives: To understand factors associated with federally qualified health center (FQHC) financial performance. Study Design: We used multivariate linear regression to identify correlates of health center financial performance. We examined six measures of health center financial performance across four domains: margin (operating margin), liquidity (days cash on hand [DCOH], current ratio), solvency (debt-to-equity ratio), and others (net patient accounts receivable days, personnel-related expenses). We examined potential correlates of financial performance, including characteristics of the patient population, health center organization, and location/geography. Data Sources: We use 2012-2017 Uniform Data System (UDS) files, financial audit data from Capital link, and publicly available data. Data Collection/Extraction Methods: We focused on health centers in the 50 US states and District of Columbia, which reported information to UDS for at least 1 year between 2012 and 2017 and had Capital link financial audit data. Principal Findings: FQHC financial performance generally improved over the study period, especially from 2015 to 2017. In multivariate regression models, a higher percentage of Medicaid patients was associated with better margins (operating margin: 0.06, p < 0.001), liquidity (DCOH: 0.67, p < 0.001; current ratio: 0.28, p = 0.001), and solvency (debt-to equity ratio: -0.08, p = 0.004). Moreover, a staffing mix comprised of more nonphysician providers was associated with better margin (operating margin: 0.21, p = 0.001) and liquidity (current ratio: 1.12, p < 0.001) measures. Patient-centered medical home (PCMH) recognition was also associated with better liquidity (DCOH: 19.01, p < 0.001; current ratio: 4.68, p = 0.014) and solvency (debt-to-equity ratio: -2.03, p < 0.001). Conclusions: The financial health of FQHCs improved with provisions of the Affordable Care Act, which included significant Medicaid expansion and direct funding support for health centers. FQHC financial health was also associated with key staffing and operating characteristics of health centers. Maintaining the financial health of FQHCs is critical to their ability to continuously provide affordable and high-quality care in medically underserved areas. KEYWORDS access to health care, federally qualified health center, financial management, Medicaid, Medicaid expansion What is known on this topic * Previous studies on factors associated with federally qualified health center (FQHC) financial performance focused on a limited set of financial performance measures, including overall costs, revenues, and net revenues of health centers. * More than half of the respondents from a recent survey of FQHC chief executive officers reported difficulty in maintaining financial sustainability. What this study adds * This study focuses on various dimensions of FQHC financial performance, including liquidity and solvency measures, providing a more comprehensive understanding of the financial health of FQHC. * The study results suggest that provisions of the ACA, including Medicaid expansion and direct funding support for health centers helped health centers to achieve better margin, liquidity, and solvency. * Key staffing and operating characteristics of FQHC were associated with financial performance of health centers., 1 | INTRODUCTION Federally qualified health centers (FQHCs or 'health centers') are an important source of primary care for medically underserved populations. (1) Health centers share some financial and operating [...]

Objective. To develop a short-form Safety Net Medical Home Scale (SNMHS) for assessing patient-centered medical home (PCMH) capability in safety net clinics. Data Sources/Study Setting. National surveys of federally qualified health centers (FQHCs). Interviews with FQHC directors. Study Design. We constructed three short-form SNMHS versions and examined correlations with full SNMHS and related primary care assessments. We tested usability with FQHC directors and reviewed scale development with an advisory group. Data Collection. Federally qualified health center surveys were administered in 2009 and 2013, by mail and online. Usability testing was conducted through telephone interviews with FQHC directors in 2013. Principal Findings. Six-, 12-, and 18-question short-form SNMHS versions had Pearson correlations with full scale of 0.84, 0.92, and 0.96, respectively. All versions showed a level of convergent validity with other primary care assessment scales comparable to the full SNMHS. User testers found short forms to be low-burden, though missing some PCMH concepts. Advisory group members expressed caution over missing concepts and appropriate use of short-form self-assessments. Conclusions. Short-form versions of SNMHS showed strong correlations with full scale and may be useful for brief assessment of safety net PCMH capability. Each short-form SNMHS version may be appropriate for different research, quality improvement, and assessment purposes. Key Words. Uninsured/safety net providers, primary care, psychometrics, Safety net clinics have made significant investments to increase patient-centered medical home (PCMH) capability to improve health care and outcomes, with federal and state governments providing technical assistance and financial [...]

Objective. To examine the relationship between medical home transformation and patient experience of chronic illness care. Study Setting. Thirteen safety net clinics located in five states enrolled in the Safety Net Medical Home Initiative. Study Design. Repeated cross-sectional surveys of randomly selected adult patients were completed at baseline (n = 303) and postintervention (n = 271). Data Collection Methods. Questions from the Patient Assessment of Chronic Illness Care (PACIC) (100-point scale) were used to capture patient experience of chronic illness care. Generalized estimating equation methods were used to (i) estimate how differential improvement in patient-centered medical home (PCMH) capability affected differences in modified PACIC scores between baseline and postintervention, and (ii) to examine cross-sectional associations between PCMH capability and modified PACIC scores for patients at completion of the intervention. Principal Findings. In adjusted analyses, high PCMH improvement (above median) was only marginally associated with a larger increase in total modified PACIC score (adjusted [beta] = 7.7, 95 percent confidence interval [CI]: -1.1 to 16.5). At completion of the intervention, a 10-point higher PCMH capability score was associated with an 8.9-point higher total modified PACIC score (95 percent CI: 3.1-14.7) and higher scores in four of five subdomains (patient activation, delivery system design, contextual care, and follow-up/coordination). Conclusions. We report that sustained, 5-year medical home transformation may be associated with modest improvement in patient experience of chronic illness care for vulnerable populations in safety net clinics. Key Words. Primary care, primary care redesign, medical home, patient-centered medical home, chronic disease, chronic illness, chronic illness care, patient experience, patient satisfaction, patient-oriented measures, safety net clinics, vulnerable populations, The patient-centered medical home (PCMH) has gained widespread attention as an important model to redesign U.S. primary care and address population health. Broadly, the PCMH is a physician-directed medical practice [...]

Objective. To compare utilization and preventive care receipt among patients of federal Section 330 health centers (HCs) versus patients of other settings. Data Sources. A nationally representative sample of adults from the Medical Expenditure Panel Survey (2004-2008). Study Design. HC patients were defined as those with >50 percent of outpatient visits at HCs in the first panel year. Outcomes included utilization and preventive care receipt from the second panel year. We used negative binomial and logistic regression models with propensity score adjustment for confounding differences between HC and non-HC patients. Principal Findings. Compared to non-HC patients, HC patients had fewer office visits (adjusted incidence rate ratio [aIRR], 0.63) and hospitalizations (aIRR, 0.43) (both p < .001). HC patients were more likely to receive breast cancer screening than non-HC patients (adjusted odds ratio [aOR] 2.78, p < .01). In subgroup analyses, uninsured HC patients had fewer outpatient and emergency room visits and were more likely to receive dietary advice and breast cancer screening compared to non-HC patients. Conclusions. Health centers add value to the health care system by providing socially and medically disadvantaged patients with care that results in lower utilization and maintained or improved preventive care. Key Words. Safety net, preventive care, utilization, Health centers (HCs) funded by Section 330 of the Public Health Service Act cared for approximately 21.1 million people in 2012. This program is dedicated to providing comprehensive primary care [...]