How Value-Based Care is Redefining Quality Metrics in FQHCs and RHCs

The transition to value-based care redefines quality metrics in healthcare across the board. While FQHCs and RHCs are familiar with quality reporting, understanding how value-based care metrics and reimbursement models work is essential for improving care delivery and achieving financial success.

New Quality Metrics

Under value-based care, quality metrics focus on patient outcomes, preventive care, and chronic disease management. These metrics go beyond traditional measures such as the number of services provided and instead emphasize:

  • Patient Outcomes: Metrics including readmission rates, patient satisfaction scores, and health outcomes for chronic conditions.
  • Preventive Care: Preventive services like vaccinations, screenings, and wellness visits.
  • Chronic Disease Management: Effective management of chronic conditions like diabetes and hypertension through regular monitoring and patient education.

Implications for Care Delivery

Value-based care requires a shift in how care is delivered:

  • Coordinated Care: Providers must work together across the care continuum to ensure that patients receive comprehensive, coordinated care. This will require clinics to have strong working relationships with other local healthcare providers to manage the needs of their population.
  • Patient Engagement: Engaging patients in their care through education and self-management support is crucial for achieving desired outcomes.
  • Data-Driven Decision Making: Providers need to leverage data analytics to track performance, identify gaps in care, and implement quality improvement initiatives.

Strategies for Improvement

To adapt to these new quality metrics, FQHCs and RHCs should consider the following strategies:

  • Invest in Technology: Implement electronic health records (EHRs) and data analytics tools to track and report quality metrics.
  • Train Staff: Provide ongoing training for staff on the importance of quality metrics and how to meet performance goals. Coding staff must understand the various risk adjustment models. Additionally, provider documentation must be detailed to zero in on the most specific diagnosis codes to maximize reimbursement.
  • Engage Patients: Develop patient education programs and support services to encourage active participation in their care.

At BCA, we offer expertise in helping FQHCs and RHCs adapt to these new quality metrics and coding methodologies to show the results of care quality initiatives. Our comprehensive support services include EMR analysis, coder, biller, and clinician training. Discover how we can help you succeed in the value-based care landscape by contacting us at