Transforming Financial Stability at FQHCs with PointCare
Executive Summary
A Federally Qualified Health Center (FQHC) in Central Texas serves nearly 75,000 unique patients annually across multiple clinics. Their mission is to provide comprehensive primary healthcare to all community members, regardless of their ability to pay.
Coming out of the public health emergency due to the COVID pandemic, the FQHC faced financial strain as Medicaid disenrollment increased and uninsured patient care costs escalated. The clinic needed a sustainable solution to mitigate coverage gaps, protect revenue, and alleviate the administrative toll on its overburdened staff. By implementing PointCare’s coverage management platform, the FQHC streamlined enrollment processes, empowered its patients, and reduced Medicaid lapse rates.
The result? The clinic reclaimed nearly $1 million in lapse recovery value and reduced the cost per coverage by over 80%. What once cost $158 was optimized to cost $29. This case study explores how PointCare’s solutions contributed to the FQHC’s financial outlook and reinforced its mission to deliver equitable, patient-centered care.
The Challenge
For this FQHC, the stakes were immense. Serving a largely low-income community—where one in three patients is uninsured—maintaining a balanced payer mix of Medicaid, Medicare, and commercial insurance is vital to providing comprehensive care for all, regardless of their ability to pay. However, after the COVID-19 public health emergency, thousands of eligible Medicaid patients in the state lost coverage due to administrative and procedural hurdles, despite remaining eligible.
Key challenges included:
- Rising Medicaid Disenrollments:
Patients failed to re-enroll on time, leading to lapses in coverage. Visits from patients with Medicaid coverage dropped by nearly 25%.
- Growing Uninsured Costs:
With more patients losing Medicaid, the clinic faced increased costs for providing uncompensated care, straining limited resources. - Administrative Challenges:
Staff spent hours navigating Medicaid’s complex requirements, taking time away from patient care.
“A large number of patients went from having Medicaid as the primary payer to no payer at all. Patients paying out of pocket, often paying our minimum fee,” shared the CFO of the FQHC. “And it is a vast reduction in patient services revenue, while still maintaining care for the same number of patients at the same number of visits on a month-to-month or annual basis.”
The Results
The implementation of PointCare produced measurable and impactful outcomes for the FQHC:
- Enhanced capacity to support patient enrollment and retention: By augmenting the financial eligibility team to handle increased outreach and enrollment efforts, the FQHC was able to achieve an effective lapse recovery rate of 32.8% of Medicaid patients lapsed for procedural reasons.
- 81.7% Reduction in Per Medicaid Re-Enrollment Costs: Pairing CoverageCare patient outreach via texts, calls, and emails enhanced existing patient outreach efforts and reduced the overall costs for each enrollment.
- 3/10 Recovery of Lapsed Patient Coverage: With fewer uninsured patients, uncompensated care expenses dropped, improving the sustainability of the FQHC’s operations.
“Essentially [PointCare has] increased capacity to maximize patient access to coverage that benefits both the patient and the health center financially,” shared the CFO of the FQHC.
This FQHC’s success demonstrates how implementing a coverage management strategy can help Federally Qualified Health Centers overcome Medicaid coverage challenges and secure financial stability. If your clinic is struggling with similar issues, it’s time to take action.
