CHCs, FQHCs and RHCs Struggle with Primary Care Models

New policies from the Centers for Medicare and Medicaid Services are disrupting rural health clinics’ participation in value-based payment models. But a new study shows that while federal programs have increased patient access and quality of care, they have thus far failed to curb rising costs.

When the Trump administration entered office, the name of the game was cutting programs the administration believed encouraged waste, fraud and abuse. One of the programs that got cut was the Making Care Primary (MC), intended to boost primary care programs in rural areas by paying clinics to address patient needs. KFF reports that last March, clinic administrators received notice that the year-old program — which was supposed to continue for a decade — would be ended by the Department of Government Efficiency (DOGE).

The model was to be tested in eight states, including Colorado and New Mexico, and built upon programs like the Comprehensive Primary Care (CPC), CPC+ and Primary Care First (PCF) models, and allowed clinics to adopt population-based payments to build out infrastructure to improve behavioral health services and the integration of other specialized care, according to the CMS website.

Since the end of Making Care Primary, the CMS Innovation Center will launch the Long-Term Enhanced ACO Design (LEAD), which will send funding to healthcare organizations managed by larger companies instead of directly to primary care providers and clinics. CMS has declined to state the cost of the upcoming program, or the cost of eliminating MCP.

A study published in November shows that the past ten years of federal investment in primary care transformation has had great success in improving the delivery and coordination of care, but has failed to curb spending. Medical Economics explains that the study analyzed 142 studies and evaluation reports from CPC, CPC+, EvidenceNOW Advancing Heart Health, the Federally Qualified Health Center (FQHC) Advanced Primary Care Practice (APCP) demonstration and the Multi-Payer Advanced Primary Care Practice (MAPCP) model. From the study’s authors:

Expecting organizations that are paid single-digit percentages of the total cost of patients’ health care to change the cost of care is a proposition that has not borne fruit.

Every year, FQHCs provide care to more than 30 million patients, including primary care for patients regardless of their ability to pay. In addition to traditional primary care, they provide behavioral healthcare, transportation assistance and more, especially in rural communities. A 2024 Commonwealth Fund National Survey of FQHCs found that nearly all offer timely appointments, expanded hours of care, telehealth services and two-thirds have made substance abuse disorder treatment (66%) and medication-assisted treatment (62%) available to patients. Most face severe workforce shortages and find it difficult to obtain specialty care appointments for their patients, especially Medicaid enrollees and the uninsured.