Wednesday, October 31, 2018

New Report Highlights Financial and Workforce Characteristics of High-Performing Health Centers

The nation’s highest performing health centers can be classified as having strong clinical quality as well as financial health, but are there lessons to be learned about their workforce models? Capital Link and the Association of Clinicians for the Underserved (ACU) explored this question in a study examining the workforce and financial characteristics of high-performing health centers to begin to understand the success factors among a variety of staffing models for potential replication.

Developed with support from the Health Resources and Services Administration, Identifying Workforce and Financial Characteristics of High-Performing Health Centers is a report of findings comparing financial and workforce metrics of High Performers against Non-High Performers and median results of Federally Qualified Health Centers nationally to identify effective models for potential replication and areas for further research.

The report highlights the following findings:
  • High-performing health centers demonstrated operating margins approximately three times higher than national and non-high performing health centers
  • High Performers had nearly three times the cash reserves of Non-High Performers and national health centers, at the median
  • Provider mix at the high-performing health centers was comprised of approximately 60% physicians and 40% non-physicians
  • A 2 to 1 ratio of primary care support staff to providers for High Performers was higher than peer groups, a finding that supports research on effective team models
  • The average tenure for CEOs for High Performers was over 10 years, approximately 60% higher than both peer groups

Further analysis on the influence of workforce models on financial and operational performance would provide additional insight on replicable models. To learn more about the findings, access this new resource here.

Friday, October 19, 2018

Updated Report Highlights Financial and Operational Trends of Community Health Centers from 2013-2016

Community health centers across the United States saw an expansion of service sites and patient visits from 2013 to 2016. Due to an increase in the insured patient population, health centers were more fully compensated, and therefore, able to improve their financial position to support this growth.

Capital Link’s newly release report, FederallyQualified Health Centers Financial and Operational Performance Analysis,2013-2016, provides an aggregate profile of financial and operation trends of community health centers, nationally. The report identifies strengths, challenges, and opportunities for performance improvement within these functions, which health centers can then use to develop a framework to review their individual practices and support change. 

The report uncovered interesting findings, including statistics related to growth and expansion, productivity and utilization, financial measures, and quality of care. Most notably:

·         There was significant growth in both patients and visits over the four-year review period. Health centers were busy in 2016, providing services to nearly 26 million patients and conducting over 104 million visits. This was a major increase from 21 million patients and 85 million visits in 2013.

·         There was a substantial shift in insurance coverage over the review period. Uninsured patient rates dropped from 34% of patients in 2013 to 21% in 2016, while Medicaid coverage increased, from 34% of patients in 2013 to nearly 45% in 2016.

·         Patient growth and an improved payer mix were partially responsible for a 47% increase in revenue from 2013-2016, with health centers bringing in $24 billion nationwide in 2016.

·         Productivity declined across several functions over the four-year period, likely due to changes in care models and clinical practices. Physician visits and mental health visits per provider experienced the largest declines at -7% and -6%, respectively.

·         Health centers experienced a 18% increase in cost of care for both patients and visits. Averaging approximately 6% per year, it was slightly higher than the rate of increase in physician and clinical expenditures.

·         An overall look at health center financial stability from 2013-2016 found that 75% of health centers operated in a steady environment, while 25% operate under fragile financial conditions.  

The analysis also looked at health center quartiles to examine strategies of high performers for replication, and areas of improvements for low-performers. The report was developed with support from the Health Resources and Services Administration.   

To access this new resource, please click here.

Thursday, October 18, 2018

PACE at Community Health Centers

Capital Link is proud to be participating in the PACE at Community Health Centers program, which is funded by The Retirement Research Foundation, along with our partners National PACE Association, National Association of Community Health Centers, and Galway Group.

The Program for All-Inclusive Care for the Elderly (PACE) is a national program that provides a comprehensive package of services to help enable elders to successfully remain in their homes. There are approximately 120 PACE programs across the nation, and only six are run by community health centers.

Read more about the PACE at Community Health Centers program here on NACHC’s blog.

Thursday, September 20, 2018

Examining Cost of Care at Health Centers

In the current health care environment where health centers seek to negotiate adequate reimbursement from payers and become as cost-efficient as possible, accurately tracking, comparing, and allocating costs across all service lines is critical. Yet as health centers evolve to provide a broader range of services beyond just medical, these tasks have become more complex.

Capital Link announces the release of two new cost of care resources: Cost of Care Trends for Community Health Centers 2012-2016 and Cost Per Visit – Measuring Health Center Performance. Together, these complementary resources support the ongoing focus on tracking and understanding costs in order to provide a strong foundation for current and future financial and clinical operations at health centers.


Cost of Care Trends for Community Health Centers 2012-2016 provides median health center cost trends for all services using national data from Uniform Data System (UDS) from 2012 to 2016, providing general comparative data for benchmarking. The report further breaks down the data by separately analyzing direct staff and related costs, and the allocation of facility and non-clinical support costs (overhead) for each service. Results of the analysis show that health center costs have been increasing across all service lines at a relatively rapid pace. However, there is one area where cost increases have risen at a more modest rate: cost per-full time equivalent employee (FTE). This implies that health centers have been broadening the services offered to patients without increasing the cost per-FTE. Download the full report here.


Developed by Capital Link and the National Association of Community Health Centers (NACHC) as an update to NACHC’s original 2003 publication, Cost Per Visit – Measuring Health Center Performance, reviews in detail the process and methodology for calculating the component costs of care with a focus on cost per visit across all service lines — medical, dental, mental health (including substance abuse), and vision services. It also examines methods for reducing health center costs through population health management, global payment methodologies, and tying reimbursements to outcomes. Download the Issue Brief here.


For more information on this topic, attend Capital Link’s upcoming webinar, Managing Your Health Center's Cost of Care on Wednesday, September 26, 2018 2-3 p.m. ET. Click here to learn more and register.

Capital Link will soon be launching two new reports that can be customized using individual health center cost of care data: Cost Comparison Profile and Cost Comparison Snapshot. Details and ordering information will be released in the next month, so keep an eye out.

Tuesday, May 15, 2018

New Report Measures Health Center Reporting of Social Determinants of Health Interventions

While increasing access to health care and transforming the health care delivery system are important, there has been growing interest in the impact of social, economic, and environmental factors to health and well-being. Community health centers have long served both the clinical and non-clinical needs of their patients and collaborated with community and social support services. A natural extension of this commitment is to track their patients’ social determinants of health requirements, such as The Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE), in order to begin to inform care plans and connect patients to community and social services.

As health centers begin to offer non-health related services to address the social determinants of health (SDOH), they should also collect data on (1) what services are being offered; (2) the scope and reach of these services; and (3) which SDOH interventions hold the most promise for improving health outcomes. A new baseline analysis by Capital Link, sponsored by Blue Shield of California Foundation, provides a start to measuring health center efforts to impact the non-clinical dimensions of the SDOH.

The analysis documents SDOH interventions offered by health centers as reported to the Health Resources and Services Administration’s Uniform Data System (UDS) during 2015 and 2016, the most recent data available, in California and nationwide. SDOH interventions seek to link patients with programs that provide social and economic opportunities that promote good health but are not part of the listed medical, dental, behavioral, and other health services. They are distinct from clinically-focused enabling services which facilitate access to care, and include services such as: Women, Infant and Children (WIC) programs, job training, head start programs, shelters, housing programs, child care, frail elderly support, adult day health care programs, fitness programs, and public/retail pharmacies. Prior to this review, no substantive research had been conducted on these services, although multiple studies have been undertaken on clinically-focused enabling services.

Click here for a free download of Tracking Social Determinants of Health Interventions: Health Center Reporting of Non-Health Related Services in the Uniform Data System

Over our long history of working with health centers, Capital Link has amassed a database of financial and operational information to develop field-building resources on the factors affecting health center performance, impact, and growth. For more information, visit www.caplink.org.

New Report Examines the Financial and Operational Trends of California Health Centers

Capital Link announces the release of an updated statewide financial and operational profile of California health centers. This resource, sponsored by Blue Shield of California Foundation, presents multi-year trends as well as comparative data for health centers nationally, offering a framework for identifying the financial strengths, challenges, and benchmarks that support opportunities for performance improvement.

Covering the four-year period of 2013 to 2016, this analysis focuses on the following trends for California Federally Qualified Health Centers (FQHCs) and FQHC Look-Alikes (LALs):

  • Growth and expansion of the patient population and service provision
  • Financial performance as shown by revenue growth and operating margins
  • Financial health as measured by liquidity and revenue collections 
  • Operational measures such as patient utilization and practice mix
  • Productivity metrics and quality of care indicators

Click here for a free download of California Community Health Centers: Financial & Operational Performance Analysis.

Over our long history of working with health centers, Capital Link has amassed a database of financial and operational information to develop field-building resources on the factors affecting health center performance, impact, and growth. For more information, visit www.caplink.org.

Wednesday, February 14, 2018

New Markets Tax Credit Program Allocation Awards Announced: Capital Fund Receives $40 Million


The U.S. Department of the Treasury’s Community Development Financial Institutions Fund announced the awardees for the 2017 round of New Markets Tax Credit (NMTC) allocations. The $3.5 billion in awards are aimed at revitalizing low-income communities and increasing economic opportunity nationwide. Community Health Center Capital Fund (Capital Fund), Capital Link’s lending affiliate, was awarded a $40 million NMTC allocation.

While NMTC financing is a critical source of low-cost capital and equity for health center facility projects—often securing approximately 20-22% of total project costs—obtaining tax credits is a competitive and complex process. Interested health centers must demonstrate a high level of project readiness and be able to communicate the merits of their projects to Community Development Entities (CDEs) with allocation. Furthermore, the process of structuring and closing an NMTC transaction is complicated and the terms, benefits, and fees offered to borrowers vary widely.

Capital Link has extensive knowledge of the NMTC financing process and has strong connections with Capital Fund and other CDEs interested in working with health centers. Of the nearly $1 billion in financing obtained by health centers through the NMTC program, approximately 60% was raised with Capital Link and/or Capital Fund assistance. We’ve also assisted many health centers with combining NMTC financing with HRSA capital grants—an excellent option, especially for projects of $5 million or more.

For help in determining whether NMTC financing could be a good fit for your health center, please contact
us here.


To learn more about the NMTC program and how it works, click here.