In 2023, Federally Qualified Health Centers (FQHCs) served a total of 31 million patients nationwide — and, of these patients, approximately 21 million are either uninsured or receiving Medicaid benefits. But despite this growth, FQHCs are facing unprecedented challenges threatening their ability to continue offering high-quality care to the populations who need it most.

The operational reality for FQHCs differs fundamentally from private practices and health systems. While those providers grapple with traditional healthcare economics, FQHCs navigate the intersection of PPS (Prospective Payment System) bundled payments, mandatory enabling services with minimal reimbursement, 238-hour annual UDS (Uniform Data System) reporting burdens, and patient-majority board accountability — a governance structure requiring that at least 51% of board members be active patients of the health center — all while Section 330 grants, the federal funding stream that makes FQHCs possible, cover only approximately 20% of operating costs.

In short, FQHCs are legally required to provide comprehensive enabling services but can’t bill for them adequately. Revenue models tie financial viability to face-to-face encounters while patient populations face precisely the barriers that prevent those encounters: access to reliable transportation, safe and stable housing, and healthy food, among others. Post-Medicaid unwinding, many FQHCs are managing revenue volatility while trying to maintain the service infrastructure their communities depend on.

This creates a central operational question: How can health centers deliver enabling services at scale without compromising the financial sustainability needed to keep their doors open?

Scaling Enabling Services Without Expanding Internal Overhead

FQHCs face a persistent structural problem: how to adequately staff enabling services without the revenue to support them. Section 330 requires comprehensive enabling services – case management, eligibility assistance, outreach, translation, transportation – but these services generate minimal reimbursement. FQHCs are obligated to provide them, yet they compete for resources with revenue-generating activities.

Section 330 also mandates care coordination, but this becomes nearly impossible when care coordinators are managing caseloads of 300+ patients navigating fragmented systems – and Section 330 funding remains relatively stagnant, meaning little to no runway to expand the workforce. Waymark’s multidisciplinary care teams serve as a single point of contact throughout patients’ health journeys. We coordinate with specialty providers, behavioral health services, and community-based organizations to ensure continuity of care, delivering the care coordination that FQHCs struggle to resource at scale.

Waymark provides enabling services capacity without expanding payroll. The multidisciplinary teams — comprised of care coordinators, community health workers (CHWs), licensed therapists, clinical pharmacists, and pharmacy technicians — deliver the case management, eligibility assistance, and outreach that FQHCs must provide under federal statute:

• Eligibility assistance: Waymark care coordinators support Medicaid retention by connecting patients with re-enrollment assistance that takes hours per patient but doesn’t generate billable encounters.
• Case management: Licensed therapists, clinical pharmacists, and CHWs provide the comprehensive care coordination Section 330 mandates. Waymark coordinates across specialists, behavioral health providers, and community-based organizations, managing the complex work that consumes disproportionate staff time.
• Outreach: CHWs conduct the proactive outreach the statute requires but that proves difficult to operationalize when staff are managing current patient volumes. Waymark reaches patients overdue for screenings and preventive care, executing the outreach work internal teams struggle to deliver at scale.
• Social determinants of health (SDOH) coordination: Waymark connects patients with housing, food assistance, utilities, and other community resources. This is the “whole person” care that patient-majority boards expect and that HRSA operational site visits evaluate, but that internal teams struggle to deliver at scale.

Waymark also provides FQHCs with population health analytics and patient identification capabilities that would otherwise require significant capital investment. Our Signal Suite of proprietary data science tools identifies patients at highest risk of poor outcomes before they disengage from care, providing the kind of predictive analytics that typically requires health centers to invest in expensive population health management platforms.

For FQHCs facing lower rates of health information technology adoption compared to private practices and limited participation in Health Information Exchanges, accessing this level of analytics capability through a partnership model removes a significant barrier to effective population health management. This predictive capability ensures FQHC staff can focus their limited enabling services resources on the patients who need them most, without purchasing, implementing, and maintaining complex data infrastructure.

The patient risk stratification that drives Waymark’s proactive outreach also helps FQHCs demonstrate to their patient-majority boards and HRSA reviewers that they’re effectively identifying and serving their highest-need populations. The utilization and outcomes data Waymark provides creates documentation that supports multiple reporting requirements.

Reconnecting with Patients Lost to Care

One of the most significant challenges FQHCs currently contend with is reaching Medicaid patients who have become disconnected from primary care. These are often the patients providers worry about most: individuals with complex health needs who aren’t showing up for appointments and whose conditions may worsen without intervention.

Section 330 requires outreach to enrolled patients who haven’t accessed care in the past 12 months — a patient segment that has grown significantly post-unwinding. But with front-office staff managing full phone queues, sliding fee scale verifications, and appointment scheduling, most health centers can’t execute the kind of persistent, relationship-based outreach this population requires. Providers are drowning in documentation requirements and prior authorizations, leaving nobody with bandwidth for the sustained engagement these patients need.

Waymark’s Signal Suite identifies patients at highest risk of poor outcomes, then our multidisciplinary care teams conduct the outreach Section 330 calls for but that internal teams simply don’t have capacity to provide. Our community health workers regularly reach out to patients overdue for critical health screenings and preventive care, connecting them with primary care appointments and community resources as needed.

An analysis of our impact, published in NEJM Catalyst, found that our model reduces emergency department visits by 20.9% and improves health outcomes for high-risk Medicaid patients. By ensuring patients return for preventive visits, we address health needs before they escalate — and before they become expensive.

Waymark also intervenes before clinic visits are even necessary. When care teams connect patients with housing resources, food assistance, transportation, and benefits enrollment, they’re addressing the social determinants that precipitate acute events. This is the care coordination FQHCs are positioned to provide but may not be able to adequately staff, and Waymark delivers it at the community level where it’s most effective.

Addressing Behavioral Health and Medication Management Gaps

The behavioral health clinician shortage hits FQHCs particularly hard. Health centers must provide or arrange mental health and substance use disorder services, yet they’re competing for scarce clinicians with health systems that offer higher compensation and less complex patient populations. 2024 HRSA data shows 93.95% of health centers using telemedicine for mental health services — a necessity driven by workforce constraints, not a strategic choice. Waymark’s licensed clinical therapists offer these services to patients wherever they are, reducing the access burden on patients with no cost or operational impact to FQHCs.

Our clinical pharmacists play an equally important role, providing medication education and proactive outreach to improve outcomes for patients who are challenging to contact through traditional means. They conduct medication reviews, address adherence issues, and help patients understand their treatment plans — interventions that improve health outcomes while reducing the burden on FQHC providers.

By embedding licensed therapists and clinical pharmacists within care teams, Waymark helps FQHCs satisfy these service requirements without the recruitment and retention challenges that have intensified post-pandemic. Waymark clinicians focus on the high-risk Medicaid population FQHCs serve, delivering behavioral health access and medication management that’s difficult to staff adequately through traditional hiring.

Facilitating Eligibility and Coverage Support

Section 330 requires FQHCs to help patients understand, apply for, and maintain health insurance coverage. But when staffing is already thin, the administrative burden of supporting patients through insurance transitions is in direct competition with clinical priorities.

For health centers managing workforce depletion while trying to maintain service capacity, having staff available to help patients navigate coverage retention and re-enrollment represents a significant operational challenge. This obligation consumes hours per patient but competes for resources with revenue-generating clinical activities.

Waymark’s community-based care teams are equipped to deliver this eligibility assistance at scale. Our care coordinators support Medicaid retention by connecting patients with re-enrollment assistance and helping them navigate coverage transitions. When patients maintain or regain coverage, FQHCs can continue delivering the care these populations need rather than absorbing uncompensated care costs or losing patients entirely.

Supporting Consistent Care Delivery Amidst Resourcing Challenges

FQHCs are navigating operational pressures that differ fundamentally from other healthcare providers: statutory obligations to provide comprehensive enabling services that generate minimal reimbursement, patient populations facing significant access barriers, extensive compliance requirements consuming hundreds of staff hours annually, and patient-majority boards expecting measurable community impact.

Waymark addresses these structural challenges directly. Our multidisciplinary care teams deliver the enabling services that FQHCs struggle to resource at scale — without expanding internal overhead, functioning as an extension of your care delivery infrastructure rather than another vendor relationship to manage.

The infrastructure Waymark has built — predictive analytics through our Signal Suite, care coordination capacity, documented utilization management — also positions FQHCs for success in value-based arrangements. But the immediate value is simpler: delivering the enabling services your communities depend on in a way that supports both a patient-first mission and the financial sustainability needed to keep your doors open.