Federally Qualified Health Centers (FQHCs) have partnered with ReferWell to solve their most urgent challenges related to care delivery. ReferWell helps FQHCs drive more efficient care transitions for underserved populations while identifying new revenue to support the invaluable care that health centers offer their communities.
Challenges Solved for FQHCs
Expand Access to Specialists
ReferWell improves access to care for patients in need of specialty care. We curate a complete list of specialists who will accept Medicaid referrals so health center physicians can direct care transitions to the appropriate option, personalized to each patient's needs.
Get Patients to Referral Appointments More Often
With ReferWell, you schedule referral appointments at the point-of-care and the system handles all automated reminders for you. We're helping health centers increase patient follow-through for recommended care to 73% for Medicaid patients, more than doubling the current visit rate.
Coordinate Care With Providers Outside the FQHC
We give your FQHC visibility and data sharing capabilities outside your walls. Send clinical data to the external specialists, track that patients completed their scheduled referral appointments and receive consult notes back twice as often as the national average.
Capture New 340B Revenue to Fund Your Mission
Most covered entities only capture 2% of their available 340B Program revenue through specialist referrals. We're giving health centers the tools to drive that toward 100%, giving you new revenue to support your community initiatives.
“Before ReferWell, it would take us 30 minutes to find the right specialist and schedule our patients. Now, we are able to find the right specialist for our patient, see availability and schedule appointments while patients are in the office.”
– Patient Referral Supervisor, large urban health center
Explore Solutions for FQHCs
About Federally Qualified Health Centers (FQHCs)
FQHCs are community-based clinics that serve patients with limited or restricted access to health care. Typically, FQHCs serve underinsured and uninsured individuals, low-income individuals, seasonal and migrant workers, immigrants and homeless people.
The FQHC is designed to provide comprehensive primary care by involving the local community that they serve. There are currently 1,300 FQHCs across the United States that serve more than 22 million patients per year.
FQHCs are required to take all patients, including Medicare and Medicaid, and offer discounted or free services for the uninsured, depending on their income level.
FQHCs are supported through a combination of Medicaid and Medicare payments (42%), grant revenues (35%), plus state and federal funds. The Affordable Care Act in 2010 allocated $11 billion over five years to support the ongoing efforts of FQHCs.
As a result of their patient base, FQHCs have led the conversation on the importance of addressing social determinants of health.
Challenges Faced by FQHCs
The primary care provider (PCP) at the FQHC serves as the patient’s care quarterback and is sensitive to the need to coordinate the patient’s access to care. However, that coordination is difficult because today, only one out of every three FQHC patients who are referred to a specialist will successfully complete an appointment. This is because the burden of finding and scheduling the appointment is left to a patient, who is often lacking in resources, compounded by the fact that a lot of providers prefer to avoid these types of patients.
All of these missed specialist visits result in patients getting sicker and often seeking care in the emergency room, creating poorer health outcomes and unnecessary health care spend.
Another challenge is that the PCP doesn’t know which patients went to the specialist. Plus, when a patient does show up, the PCP only finds out the result of the visit around 35% of the time.
The 340B Drug Pricing Program
The U.S. government started the 340B Program in 1992 to allow qualifying hospitals and health centers — referred to as covered entities — to purchase outpatient prescription drugs for their patients at substantial discounts. These discounts range from 20% to as high as 50%. FQHCs may be reimbursed at the full rate if the prescription is filled at a designated contract pharmacy.
This process gets tricky when the health center’s physicians refer patients for specialty care. Too often, the FQHC is unable to prove ownership of patient care because there is no good way to track that the appointment happened and receive notes back from the specialist.
Many FQHCs fail to capture 340B prescriptions from referrals, causing them to miss out on significant savings. In fact, the average 340B capture rate is just 2% for prescriptions written by a specialist outside a covered entity. In other words, FQHCs lose 98% of these revenue-generating opportunities.