Just because it looks like a federally qualified health center (FQHC), doesn’t mean it always is one. Known as FQHC “look-alikes,” these arrangements are designed with the same goals of integrating primary care into behavioral health, but are done without the same funding as a traditional FQHC.
During a session at the 2012 National Council Conference called “Should You Become an FQHC Look-alike?”, Alexander Ross, ScD, Office of Special Health Affairs, Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services, explained how HRSA can help organizations through the process, before introducing two that already have.
“If you become a look-alike, you’re hitting that important point where you’re bringing together as many of the key pieces as you can in one organization,” said Ross. “Really that is what you’re striving to [achieve].”
First up was John Gardin, PhD, ACS, director of behavioral health and research for an organization called Adapt (Roseburg, Ore.). Gardin said that a few years ago the “wind shifted” and they needed to be involved in primary care. They soon applied for a rural health outreach grant with HRSA and used it to create a model for care.
“The reason we went in that direction was because the vast majority of people with mental health and substance abuse problems don’t go to those specialty clinics; they go to the primary care provider,” he said.
For Oakland County Community Mental Health Authority, Auburn Hills, Mich., a half hour north of Detroit, urgency was a key factor. “We didn’t want to wait and rely on Healthcare Reform in 2014,” said Jeff Brown, the authority’s executive director.
“We wanted to improve the health of the people we serve right now,” Brown said. So Oakland County moved forward with becoming an FQHC, first creating a 501c3 that made them an independent organization.
Some difficult decisions involved whether to build a new practice or “mesh” with an existing one. Eventually Oakland County found a partner who had “common outcomes and was interested in clinical integration.”
Of course, the arrangement isn’t for everyone. First of all, if you’re a look-alike, you have to make a commitment to finance the losses until the federal government lets you know that you’ve reach look-alike status.
“You need the cash flow to sustain the organization until the increased payment mechanism kicks in,” Brown explained. “You need to have the cash to devote to this.”