FQHCS & Community Health Centers
Your Patients Face More Barriers Than Your Team Can Handle.
FQHCs and community health centers serve the populations with the greatest need — and the greatest distance from care. You can’t afford to let a scheduling gap, a missed appointment, or a lost follow-up become a health crisis.
The Pressure on FQHCs Has Never Been Greater
- HRSA performance metrics, UDS reporting, and PCMH recognition all hinge on your ability to demonstrate comprehensive, continuous care — not just acute visits.
- Your patient population faces compounding barriers: transportation, language, work schedules, distrust of the healthcare system, and social determinants that don’t resolve on their own.
- No-shows and patient disengagement cost your center in direct revenue, UDS performance, and grant reporting. Every missed appointment is a missed quality gap closure.
- Community health centers are being asked to do more with less — expanded panels, increased complexity, staffing shortages — and the administrative burden of outreach falls on clinical staff who are already stretched thin.
Navigation Built for the Patients Who Need It Most.
ReferWell was built on the belief that access to care isn’t just about proximity — it’s about human connection, persistent follow-through, and meeting people where they are. That’s the work FQHCs and CHCs do every day. We’re here to scale it.
ReferWell brings two complementary capabilities to FQHCs: ReferWell Connect™ for referral management and loop closure, and ReferWell Engage™ for patient outreach where a human in the middle can coordinate scheduling activities and address payer quality goals. Together they address all sides of the payer-provider-compliance relationship that FQHCs uniquely straddle.
Our patient navigators speak the member’s language. Multilingual outreach, culturally relevant scripting, and scheduling flexibility (including evenings and Saturdays) remove the barriers that automated tools can’t.
Proven Impact Across FQHCs
97%
8,000
4 wks
How It Works
PCP orders and signs off on the referral, ReferWell takes it from there:
Prior authorization submission, and approvals obtained
Patient Navigators conduct outreach in the patient’s preferred language, at the right time — real people, not automated calls to schedule their specialty visit.
Visit reminders are sent, validation of visit is obtained, and progress notes are loaded into the patient chart for full referral loop closure with HRSA-compliant workflows.
Prior authorization submissions, follow-up scheduling, and referral loop closure are documented in your EMR with HRSA-compliant workflows.
Outcomes are documented to support UDS reporting, grant requirements, and quality measure performance.
ReferWell can also identify patients overdue for preventive, chronic, or specialty care based on your panel data to facilitate closure of payer quality measures.
What FQHCs & CHCs Gain With ReferWell
Your financial health is increasingly tied to three streams: higher effective PPS revenue, additive MCO incentive dollars, and shared savings. However, unmanaged “referral leakage” often acts as a silent killer of these margins.
When referrals fall through the cracks, it’s not just a care coordination issue, it’s a direct hit to your bottom line. We’ve found that high-performing referral networks drive value for FQHCs in three critical areas:
Maximizing Medicare PPS & Wrap-Around Payments
100% Reimbursement: Most Medicare-covered preventive services (AWV/IPPE) are paid at 100% with coinsurance waived, supporting higher visit volume.
The 34.16% Bump: New-to-clinic and IPPE/AWV visits trigger a 34.16% PPS increase.
Capture Every Dollar: For Medicare Advantage, if a plan pays less than the PPS rate, you are entitled to "wrap-around" payments, but only if the encounter is completed and documented.
Capturing MCO Quality Bonuses (HEDIS/APM)
Closing Gaps: Medicaid MCOs pay quality bonuses for closing HEDIS gaps like cancer screenings and diabetic eye exams, services that rely heavily on completed specialist referrals.
Protected Revenue: CMS has explicitly affirmed that these quality bonuses and shared savings are additive and do not count against your supplemental payments.
Lifting Quality Scores: As states move FQHCs into Alternative Payment Models (APMs), your PMPM rates are directly lifted by the better-quality scores that closed-loop referrals provide.
Reducing High-Cost Utilization
ER Diversion: Effective coordination for high-risk patients reduces avoidable ED and inpatient use, which is exactly what shared-savings programs reward.
Operational Efficiency: Moving from manual faxing to a closed-loop system saves hundreds of staff hours that can be redeployed to revenue-generating work.
The Bottom Line: Even a 20–25% lift in referral completion can translate into meaningful added visit volume and incentive reimbursement over a year.
If you are looking to move the needle on your HEDIS scores or protect your shared-savings pools this year, I’d love to share how we’ve helped other FQHCs operationalize their referral data to capture these dollars.
The patients who need care the most are the least likely to get there without help. That’s not a technology problem — it’s a human one. And it’s one we know how to solve.