The Primary Care Question

By Monica E. Oss, Chief Executive Officer, OPEN MINDS

Whole person care and value-based reimbursement are moving forward in fits and starts. A new and interesting model was just announced by the California Quality Collaborative and the Integrated Healthcare Association. This new contract will cover 40 employers with 17,000 members—engaging 11 provider organizations and 100 care sites in a value-based payment model.

Like many similar initiatives, the “anchor” for this contract is primary care capacity. Quoting one of the participating executives, “By co-investing in a unified value-based payment model and providing technical assistance for practice transformation, we’re better supporting primary care practices in ways that can improve patient outcomes. And high-functioning primary care is the foundation of a high-quality and cost-effective health care system.”

These initiatives raise the question for many executives of specialty provider organizations—what is our integrated care strategy? And should we invest in primary care capacity? We heard of the firsthand deliberations of one executive in the session, Should I Become A FQHC Or A CCBHC?—HealthPort’s Journey From Attempted Look-A-Like To CCBHC Status, at the 2024 OPEN MINDS Executive Leadership Retreat. Dimitri Cavathas, Chief Executive Officer at HealthPort, led a discussion of the advantages—and challenges—of changing models.

Headquartered in Salisbury, Maryland, HealthPort is a $22 million non-profit rural safety net health care and housing provider organization. The organization provides the community with primary care, outpatient mental health services, addiction treatment, and a Certified Community Behavioral Health Clinic (CCBHC) program.

Before becoming a CCBHC, HealthPort pursued the Federally Qualified Health Center (FQHC) look-alike model. While they met the qualifications, they didn’t receive federal funding through the Health Resources & Services Administration (HRSA). “Being an FQHC look-alike does not guarantee financial success,” said Mr. Cavathas. “There are FQHCs and FQHC look-alikes that go out of business. Is becoming an FQHC model worth the 33% boost in payment? To add the administrative burden, regulatory requirements, and malpractice and other issues without help, I think the calculation is not there. And FQHC is designated based on need, and we looked at the need, and it wasn’t there.”

He said the FQHC look-alike model offers some notable advantages, including the potential for increased reimbursement—up to a 33% boost in payments—and recognition for meeting federal primary care standards. However, it also comes with significant disadvantages. Organizations with this status do not receive direct federal funding, face a high administrative and regulatory burden, must navigate complicated payment structures, and often have limited legal ties to existing behavioral health services, hindering care integration.

Ultimately, HealthPort shifted its focus to the CCBHC model. The decision was grounded in a desire to build a truly integrated care organization without the complexity and limitations of FQHC status. As a CCBHC, HealthPort was able to deliver outpatient primary care and behavioral health care, add medication-assisted treatment, operate an onsite pharmacy, and implement care coordination through population health home services.

Mr. Cavathas outlined several steps to get started as a CCBHC including allocating space within the facility and hiring primary care staff and getting those staff enrolled in Medicaid and Medicare. There are also business issues to attend to—including updating coverage and enhancing electronic health record (EHR) system capacity. He also noted that opening a CCBHC program required a cultural shift—embedding a pharmacy for care continuity, hiring mission-aligned staff across disciplines, and embracing telehealth to expand rural access.

Weighing the advantages and disadvantages of the 80+ integrated care models in today’s market is not a one-size-fits-all issue. I spoke to two of my associates, Christy Dye and Deanne Cornette, and they offered some great insight. According to Ms. Cornette, for organizations considering FQHC status, the advantages include substantial sustainability through enhanced reimbursement and access to 340B pharmacy pricing. And when matched with the right population need and infrastructure, FQHCs can be an engine for scaling whole person care.

When we talk about the challenges of FQHC, “the administrative lift and compliance burden that come with FQHC status can be overwhelming for smaller organizations or those not equipped with a mature back-office infrastructure. Reimbursement is only part of the equation—if your organization can’t keep up with the reporting, auditing, and clinical integration demands, it could backfire,” said Ms. Cornette.

And for those considering a CCBHC, Ms. Dye noted that CCBHCs are one of the most scalable paths for behavioral health provider organizations to deliver integrated care and build population health capacity. “The model aligns with value-based care in a way that allows organizations to truly meet people where they are, especially in rural or underserved areas… The federal government has demonstrated an appetite for deepening CCBHC roots in the Medicaid program by expanding state opportunities to participate in the Medicaid Prospective Payment Demonstrations. Ten new Prospective Payment System (PPS) Demo states were added to the program in 2024. And in January, 14 new states and D.C. were awarded planning grants to prepare for the third wave of CCBHC Medicaid Demonstrations.”

But, according to Ms. Cornette, “the biggest misconception about CCBHCs is that it’s just about funding—it’s not. It requires a total organizational transformation. The expectations for access, data, staffing, and care coordination are high. If you aren’t ready for that level of operational change, you’ll struggle to deliver on the promise.”

For any specialty provider, choosing the right integrated care model involves weighing administrative complexity, clinical needs, and financial return. The HealthPort case shows that the “right” choice depends on your market, resources, and ability to execute. The key is to ensure your leadership team fully understands the trade-offs—and aligns the model with your organization’s long-term strategy and goals.