Alternative payment systems have helped federally qualified health centers operate at high capacities during the COVID-19 pandemic because they tend to allow more flexibility in how funds can be used and predictability about when payments are made. Volume-based payment relies on patients coming into a clinic. Especially early in the outbreak, that wasn’t happening nearly as much as usual.

“Given the disruption that COVID caused at the onset of the pandemic, prospective payments, like primary care capitation, would have allowed health centers to commit 100% of their attention to public health and patient care, and not spend time worrying about an acute decline in cash flow,” Community Care Cooperative CEO Christina Severin said.

Conversations about system transformation that began before the pandemic are starting to resume, said Jeremy Crandall, director of state affairs at the National Association of Community Health Centers.

But community health center leaders are burned out, which could prolong the process of effecting change, said Rob Saunders, a senior research director at the Duke-Margolis Center for Health Policy.

Community of Hope in Washington is enduring that challenge now, said CEO Kelly McShane. “We, like other places, are seeing a lot of turnover. People are really tired, are sick of change, and then to come in and be like, ‘ OK, so we’re going to totally upend how we do this—it would be difficult to deal with too soon.”

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