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Big FQHC Mission, Small Financial Margin

by Jenny Englerth, CEO of Family First Health

The Federally Qualified Health Center (FQHC) where I work was founded the same year I was born. I make that point because it always gives me perspective on my role as CEO and steward of this valuable community asset; people have come before me and many will follow.

Those that founded Family First Health in York, PA in 1970 did the hard work. They built a health center at a time when the nation and our community were fractured by social unrest that culminated locally in an altercation that left a young African-American woman and white police officer dead. How can a health center help heal something like that?

“He who has health has hope and he who has hope has everything.”
—Dr. Martin Luther King

Today, we continue to build health and hope for 21,000 individuals in South Central Pennsylvania. Our mission to provide high quality, affordable health care for all continues to be relevant in 2013. Health disparities exist: the ZIP code in which a child is born today will determine their health status as an adult nearly as much as it did in 1970. But today, as an FQHC, we are navigating uncharted waters filled with new expectations, new acronyms, new competitors and an ever-present risk that our patients are at the greatest risk of being left out of advances in health care simply because of their station in life.

Over the past two years, our own team became increasingly cognizant of the fact that we are experiencing a different type of disparity. While we worked to build trust and engagement in populations often distrustful of “establishments,” and grow our sites and services to meet a growing primary care need, other better-resourced health care providers were building sophisticated IT systems to collect big data, developing new payment models, and investing in human resources in ways we could not afford.

We came to a fork in the road: at one turn, we could succumb to market forces. At the other, we could redesign our delivery system to leverage our expertise in delivering cost-effective primary care to diverse populations. We chose the road to a new way of doing business.

Family First Health caregiver and patient


We recognized that we were already doing “population management”—we just needed the data to define our impact. We took a hard look at our existing EHR (electronic health record) and practice management products to see how far they would take us toward this new model. The answer: Not far enough. So we set these five broad criteria that we needed to meet with a new technology partner and began evaluating our options:

  1. Provide clinical staff with a reliable EHR that allows for efficient and accurate documentation of patient visits and access to pertinent patient health information.
  2. Adopt an EHR with evidence of sustainability through Meaningful Use Stages 2 and 3, ICD-10, etc.
  3. Improve revenue cycle metrics including Days in Accounts Receivable and Bad Debt; increase Pay-for-Performance revenue.
  4. Decrease costs associated with ongoing hardware and infrastructure needs.
  5. Ensure timely access to population-level data that meets current reporting requirements, and will support full participation in emerging care and payment methodologies such as Accountable Care Organizations.

Being able to satisfy these requirements was foundational to our transformation work, so we left no stone unturned. We evaluated numerous traditional software products, hosting options, and outsourcing before we were introduced to athenahealth’s offerings. We believe we found a partner that not only meets the criteria, but has the expertise we need but have no way of developing independently.

As our teams work together to prepare our staff for go-live in November, we are getting what was promised: competent professionals intent on providing tools and services to improve our business. But we are also getting something we did not expect: the opportunity to interact with people that want health care delivery to improve for everyone. athenahealth seems to share our mantra of not letting the pursuit of perfection get in the way of doing some good today.

This is significant for us, especially as an FQHC. Doing some good today was what our founders embraced 43 years ago, and it is what our patients expect from us each day. With our new partner, we expect to increase the pace of clinical transformation and more effectively engage patients. We also plan to own the evidence of our efforts to inform continuous improvement, engage stakeholders and prove our impact. And with that, I will have done some good that can be passed on to the next stewards of this invaluable community asset.

Jenny Englerth is the CEO of Family First Health in Pennsylvania, an athenahealth client.

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