The Importance of Our Community Health Centers

With National Health Center Week just wrapping up a couple of weeks ago (August 3-9, 2025), I think it is timely to highlight the work and obstacles that our community health centers across the country are facing, especially in light of increased regulation and decreased funding.

What Are Community Health Centers?

First off, for those of you who aren’t aware, Community Health Centers (CHCs) or Federally Qualified Health Centers (FQHCs) as they are also known are community-based health clinics that provide primary care and, in many cases, also provide other comprehensive services such as mental health, dental, pharmacy, and other key services designed to strengthen the health of the communities that they serve. These health centers are patient-governed with at least 51% of their board members being comprised of patients of the health center and the board composition matching the demographics of the community in which they operate. These FQHCs typically operate in underserved areas ensuring essential access to health care services for those who might have barriers to access elsewhere such as cost, no insurance, or language differences. FQHCs offer sliding fee schedules to accommodate those who don’t have insurance and might not be able to fully pay for their health care treatment. These health care centers provide a health care “safety net” for the populations that they serve ensuring that they always have access to essential health care services to improve the health of the communities they serve.

How Are FQHCs Funded?

Now that we all know what FQHCs are and the essential services that they provide, let’s talk a little bit about how they are funded. Like all health care providers, FQHCs have a mix of payors that fund or reimburse them for the services that they provide. These payors can include Medicaid programs, Medicare, federal grants, and to a lesser extent, commercial insurance payors. Additional sources of funding may also include private grants and donations. Federal grants for FQHCs are administered by the Health Resources and Services Administration (HRSA) which is part of the Department of Health and Human Services (HHS). These are competitive grants where potential grantees have to demonstrate need in their community and ability to serve that need. HRSA then looks at all grant applications and determines which communities have the most demonstrated need based on socioeconomic, demographic, and available health care resources to determine which areas qualify for the limited new grant funding available each year. Once a grant is awarded, a grantee has to continue to demonstrate performance through the annual submission of Uniform Data Systems (UDS) reports to HRSA which provide information on patient demographics, services, and outcomes which HRSA then uses to assess program performance and recommend quality improvement programs. Additionally, FQHCs are subject to intensive weeklong site visits either annually for newer or lesser performing FHQCs to every three years for more mature, higher performing grantees. 

To be clear, FQHCs probably have some of the most rigorous reporting and review requirements of any federal grantees and taxpayers can be assured that money spent on this program is not only put to the use that it was intended, but that those dollars are achieving measurable outcomes in the communities in which they are invested. The word "invested" in the last sentence is critical here as these programs aren’t entitlements as some politicians would like to frame them, but rather they are investments in the health of communities all around our country. Without healthy communities, we truly cannot have a healthy country, and these programs are quietly contributing to overall health and well-being of our country one community at a time.

Another service that many FQHCs provide is pharmacy services through a program administered by HRSA known as the 340B program. This program allows eligible entities such as FQHCs to access drugs from pharmaceutical manufacturers at deeply discounted rates. The FQHCs in turn use these savings to provide free or reduced-cost prescriptions to patients. In many cases, these pharmacies operated by FQHCs are the only pharmacy available in the community.

So, now that we have discussed what FQHCs are and their importance to the overall health and wellbeing of our communities, let’s talk about the challenges that FQHCs face. I am going to break these down into the following categories:

1. Funding
2. Workforce Shortages
3. Administrative Burdens and Regulation

Funding

We have talked a little bit about the sources of funding that FQHCs face. Unfortunately, most of those sources are under continuous political attack. The recently passed “One Big Beautiful Bill” is anticipated to result in the loss of Medicaid coverage for over 10 million people according to the Congressional Budget Office (CBO). Many of these recipients are currently patients of FQHCs and will probably remain patients in some respect even after they lose their Medicaid coverage. This means that in these cases, instead of receiving reimbursement from Medicaid for the essential services provided to these patients, these FQHCs will be providing care on a greatly reduced sliding fee scale which doesn’t even come close to covering the cost of those services. When an FQHC receives full Medicaid payment for a patient visit, that payment may only cover about 82% of the cost of providing the service. If that service has to be provided for only a nominal fee or even free under a sliding fee scale, that problem is greatly amplified. At the same time, grant funding is stagnate and has not kept up with inflation. Grant funding is what FQHCs depend on to bridge the gap between what they receive on fee-for-service basis to provide services and what those services actually cost. So, with inflation raising the cost of those services, fewer patients being eligible for Medicaid, and stagnate or even decreasing HRSA grant funding available to bridge the cost gap of those services, you can see how our system of FQHCs is becoming increasingly vulnerable to funding challenges. Without changes to how we prioritize and fund this valuable work, many of these essential health care centers providing safety net services are going to be forced close their doors in the coming years.

Workforce Shortages

While staffing and workforce shortages are rampant across our entire health care system, especially after COVID, the impact on FQHCs is even more dramatic. With limited funding, FQHCs struggle to compete with larger, private sector health care entities that can offer higher benefits and salaries. On top of that, many FQHCs are in rural areas which just adds to the difficulty in recruiting and retaining talent. Add to that the ever-increasing demand for FQHC services resulting in heavy workloads and high patient volumes and you have a recipe for staff burnout and dramatic staff turnover.

Administrative Burdens and Regulation

The administrative burdens and associated costs of running an FQHC are great. We already discussed the fact that FQHCs are under strict oversight by HRSA requiring submission of detailed UDS reports every year and intensive site visits, not to mention whatever regulatory burden that is imposed by state or local agencies. But in addition to that, FQHCs are increasingly being required to adopt frameworks around and address the complex needs of Social Determinants of Health (SDOH) which requires the FQHC not only to consider the patient’s physical health needs, but also things like housing or food insecurity which many traditional reimbursement models do not adequately address. SDOH requires complex coordination of services across various needs and specialties with ever shrinking resources.

Additionally, FQHCs are responsible for ensuring access to care for the populations that they serve. This means providing non-traditional care mechanisms such as telehealth services. Telehealth services require increased technology capacity and capabilities and, in some cases, even providing technology devices to their patients to ensure their ability to access services.

All health care entities are highly regulated under HIPAA which requires strict controls to protect the privacy of patient data. Compliance with these regulations require extensive and expensive compliance and cybersecurity programs. With all of the breaches of health care organizations that are occurring, the requirements under HIPAA are going to become even more extensive over the next year. These additional controls will just add to the expense and complexity of managing cybersecurity operations for FQHCs. Unfortunately, while acute (inpatient) organizations have access to funds from large technology companies like Microsoft and the federal government for cybersecurity, these funds are not made available to FQHCs. While inpatient health care is a key component of our health care system in this country, we need to keep in mind that the whole point of a healthy primary care system is to help keep our patients out of inpatient settings as much as possible. Many hospital admissions can be prevented by providing access to adequate primary care services, a fact that seems lost on our technology communities and government.

Conclusion

In this article, we have discussed what an FQHC is, how they are funded, and some of the challenges that they face to their continued survival. Through this article, I hope I have explained the urgent necessity behind our FQHC system and why they are vital to the continued health and well-being of our communities. The threats that our FQHCs currently face really threaten our entire health care system. When FQHCs are not available to provide services in their communities, that need will eventually need to be met, usually by emergency departments and urgent care centers. This additional load on our emergency departments and urgent care centers means that those services are less available to everyone else. FQHCs providing preventive and primary care services to these patients prevent that escalation in the need of care that results in emergency department or urgent care visits and relieves overall pressure on our entire health care system.

In future articles, I will address some of the challenges faced by FQHCs from my perspective as an executive responsible for the technology portfolio of an FQHC and integrated health system.

Recruitment Is a Form of Marketing!

 

During my discussions with a number of executives, many of whom I am mentoring in one way or another, the topic of how they have been treated by various organizations during the recruitment process has come up a lot. One of the biggest gripes that I hear over and over again is the lack of respect that they receive when they interview for a position and don’t receive an offer. Typically, when you make it to the step of getting an actual interview for an executive level position, you are one of only  a handful of candidates being considered. As such, one would expect that when they are not chosen, they would receive some form of personal communication regarding the decision and maybe, if the company is really on the ball, some feedback on what they liked and what they felt the candidate could have improved on. What I am hearing is that many times, all the candidate receives is the same basic form email that every other candidate receives that wasn’t even selected for an interview. “We regret to inform that we will not be moving forward with your candidacy…blah, blah, blah.” Sometimes, it is just automatically generated through Indeed or whatever platform that they posted the job on, which makes it even worse. Keep in mind, that we are only talking about the candidates that were interviewed which is typically a very small number and to whom it shouldn’t be difficult to provide personalized messaging.

What you need to understand as someone who is responsible for recruitment for your organization, especially at the executive level, is that how you treat your candidates can strongly impact how that candidate views your organization, positively or negatively.

Recruitment as Marketing

As executives, many of us have to make decisions on vendor relationships. That could be whether we want to start doing or continue to do business with a particular company. Now, think about this. You are an executive of Company A who once went through the recruitment and interview process with Company B and felt that it was impersonal and disrespectful. Company B now is lobbying heavily to do business with Company A and you are a major influencer of whether that happens. How likely are you to let that negative experience impact your decision to do business with Company B? I would say the probability of that is very high. Some might say that allowing personal experiences to impact a business decision is slightly unethical. I would argue against that by saying that your experience gave you insight into how Company B operates. If Company B is disrespectful to high-level job candidates and fails to show empathy and personal interaction for something as simple as communicating that they didn’t get the position, what makes you think that the treatment that you would get as a customer would be any better? When you are exposed to the recruitment process of an organization, you get a sneak peek into their culture. In a lot of ways, Human Resources is one of the main gatekeepers and advocates of the company’s culture. So, if your experience with HR during an advanced stage of recruitment for a high-level position is cold and impersonal, it wouldn’t be a stretch to say that approach probably permeates a lot of the culture of the company. Thus, this is where HR unwittingly becomes part of the marketing process. That negative impression that you leave with a candidate may be what prevents your company from making a sale. In some cases, depending on the organizations involved, that sale could be substantial. What HR did during that interaction completely overrode anything that the Sales and Marketing departments did to get the sale.

Going Beyond Recruitment

Now, in this blog post, I kind of picked on HR and how many HR departments are handling their recruitment processes (this is not completely anecdotal as I have experienced it myself in past job searches), however, we all need to realize that no matter our role, we are ambassadors of our organizations and not just our current organization. Many of us remember names. If we had a bad interaction with someone, we tend to remember that. That memory tends to stay with us regardless of which organization that person is currently with. Our interactions with each other matter and can build or destroy credibility. I know that these days, it is common for many to have a short-term outlook on things. Many people aren’t planning on being tied to any one organization for the long-term and don’t think that the impressions that they make during their tenure with their current organizations can have long-term impacts on them. What this short-term thinking totally misses is that most of us have long-term memories and those memories tend to follow specific people as well as organizations. So, the impression or impact you make today can have long-term ramifications. Always be aware of the impressions and perceptions that you leave. When you interact with others, you are a brand ambassador for not only your current organization, but any organization that you work for in the future.

Conclusion

HR has a lot more brand and marketing influence than I think many HR professionals realize. How often does HR’s impact on the organization’s brand perception enter the thoughts of CHROs and recruiters? I would love to hear feedback from HR professionals on this and not just the negative. If you are doing something really forward thinking and progressive to represent your organization as an HR professional, I would love to have you share that here.

Additionally, we need to realize that all of us, in our interactions with others, can impact the brand perception of our organizations – past, present, and future!

What is IT Governance and Why is it Important?

 

In my almost three decades in IT, what has truly amazed me is how few organizations actually have IT governance programs. What is even more amazing is how few C-suite leaders and other leaders even understand what IT governance is and the value that it can bring to their organizations. This group of leaders includes those within IT as well, many of whom see IT governance as a threat to their leadership. Let’s take a dive into what IT governance really is, why it is valuable and why IT leaders should actually embrace and not fear it.

What is IT Governance?

Simply put, IT governance is a framework that helps organizations manage and align their IT operations with their business goals and objectives. At the end of the day, isn’t meeting the organization’s goals and objectives what we should all be about? IT doesn’t exist in a vacuum. In order to make sure that IT is properly aligned with and working towards the organization’s goals and objectives, stakeholders outside of IT need to be involved in determining what that looks like from a strategy and performance management perspective. The goal of IT governance is to bring those outside stakeholders to the table.

Why is IT Governance Important?

So, now that we know what IT governance is, why is it so important? Bringing outside stakeholders to the table to help IT leadership create an aligned strategy ensures that the projects that IT takes on are the right projects to help the business progress. Furthermore, these stakeholders work with IT to help prioritize these projects and provide support and funding to ensure that they get done. One of the most common reasons for projects failing is unclear business objectives or poorly defined project goals and milestones. Including stakeholders in this process can help ensure that the business objectives, project goals, and milestones are clearly defined before the project is even approved and started. This increases the likelihood of project success and that the project will provide the organization value. IT governance is really a “shared responsibility” model where IT works with its key stakeholders to share the responsibility for the success of the IT department and ensure that its efforts are optimized and delivering value to the organization.

Why Should IT Leadership Embrace IT Governance?

In the traditional IT model, IT owns the total responsibility for the success or failure of its initiatives and projects and whether or not it delivers value (real or perceived) to the organization. In this model, IT leadership really becomes the scapegoat for failures related to lack of engagement and support from other business leaders. I don’t know about you, but to me, that just seems like a recipe for failure. And a lot of times, it is.

With a true IT governance model, on the other hand, responsibility for the success or failure of IT to deliver value to the business is a shared responsibility with stakeholders having input into the strategy and execution of the IT department. If done right, there really is very little reason that there should be failure as we will see in the next section when we talk about the mechanics of how IT governance works and how it delivers value.

How Does IT Governance Work?

We stated earlier that, in its most simple terms, IT governance is a framework that brings together IT leadership and leaders or stakeholders from across the organization to share the responsibility for the governance of IT. Let’s talk a little bit, in a very generic way, about ways in which this is typically achieved. Keep in mind that these are broad, high-level applications and the approach and the details required to make this work for a particular organization really depends on that organization’s needs and resources.

1. The Chief Information Officer (CIO) should be a part of the business strategy development process and should be in attendance at board of directors’ meetings. In order to ensure IT alignment with business goals and objectives, the leader of the IT department needs to be in the room when those are developed and discussed.

2.  An IT Steering Committee should be formed made up of stakeholders from across the organization. This committee makes recommendations on the IT strategy and ensures that it aligns with the overall business strategy before being passed up to the board of directors for approval. 

a.      This committee acts as a governance body for IT where key metrics and KPIs for evaluating the operational performance of IT are developed, approved, and presented.

b.     Prioritization of projects and initiatives for that the IT department works on should also generally occur in this committee.

c.      The agreed upon KPIs, metrics, and project portfolio performance should be captured in a balanced scorecard which can then be used to measure the overall effectiveness of the IT department in achieving its strategic objectives. Plans for corrective action, if necessary, can be discussed and developed in this committee and then progress against those corrective action plans can be monitored along with the balanced scorecard. 

      3.  The IT scorecard, as approved and validated by the IT Steering Committee, should then be presented to the board of directors along with summaries of any actions discussed and taken in the IT Steering Committee and project portfolio status.

Conclusion

As you can see, this model sets up an organization for the most effective use and deployment of its IT resources by ensuring that said use and deployment is always in alignment with the needs of the business as directed by the business leaders. This avoids the IT department making key decisions in a vacuum and increases transparency in the effectiveness of the operation of the IT department. This transparency increases credibility and sets the IT department up to be trusted technology advisors and a strategic asset for helping the organization scale and achieve its objectives.