So much of the work done in community health centers can feel invisible. I’ve spent my career working in and with fererally qualified health centers (FQHCs) and community health centers (CHCs). I’ve seen firsthand how community health center patients are positively impacted by the care provided at these institutions.

CHCs serve 52 million Americans. But they don’t put up flashy billboards touting awards; they serve their communities quietly. And they do it well. While they provide primary care for 14% of the U.S. population, they account for 1% of total healthcare spending, according to the NACHC.

And so much of primary care provided at CHCs is invisible outside of the exam room. When chronic illnesses like congestive heart failure, diabetes, or chronic kidney disease are managed, there are fewer emergency room visits, fewer hospital stays, and healthier patients who aren’t seen elsewhere in the system. It’s not the type of work that grabs headlines. And if that work isn’t coded consistently and correctly, CMS won’t even know a patient has a controlled chronic illness — making that work functionally invisible.

But when CHCs join value-based care models, they show their value to the system and the work becomes visible. And they can’t afford not to. 

The Cost of Standing Still

HR 1 hit most CHC leaders like a ton of bricks — a true deer in the headlights moment, when 10 million people are projected to lose health coverage from the new law’s ACA and Medicaid reductions.

1 in 4 Medicaid patients rely on CHCs for care, according to NACHC, and Medicaid generates nearly half of all CHC revenue. For these health institutions, that means a wave of patients shifting from Medicaid to uninsured, a direct hit to their bottom line.

Many leaders I speak with are in the “freeze” part of the fight, flight, or freeze response. It feels like the house is on fire and it’s impossible to focus on anything else other than Medicaid cuts. The upcoming financial crunch from Medicaid changes from HR 1 is precisely why CHCs need to embrace value-based care now.

Fight, Don’t Freeze

The instinct right now for many is to put every ounce of energy into Medicaid and let everything else wait. I understand that instinct. But waiting is exactly what CHCs can’t afford.

Now is the time for CHCs to pour more energy into their Medicare populations, for two reasons. For one, Medicare value-based care programs can help health centers generate revenue today that can keep their doors open and accessible to their community. The arrangements worth joining now invest in CHC’s readiness from day one, so the work funds itself while generating shared savings for the future.

For another, although Medicare patients have historically made up a small percentage of CHC patients, the “silver tsunami” of Baby Boomers aging into the program means the Medicare patient panel is only going to grow.

Getting the Medicare fundamentals right starts with one visit: the annual wellness visit (AWV).

AWVs are dedicated visits to address any and all chronic illnesses for a patient and are the main vehicle for physicians to get those diagnoses and treatments coded properly each year. 

AWVs aren’t just another box to check. They are an opportunity to lean in and help patients on their journey while also making the care provided visible to CMS and trackable for shared savings and quality payments in the process.

What sits underneath all of it is attribution: making sure the system actually knows which patients a health center is caring for, and for what. 

Make the Invisible, Visible

Caring for patients and getting credit for it shouldn’t be revolutionary. But acting on it in a time of uncertainty and panic takes guts and conviction.

I encourage CHC providers to embrace the documentation that value-based care requires. It’s the same instinct that drove many of us, myself included, into medicine in the first place — the conviction that a diagnosis matters, and the details are the job.

CHCs have always made an impact. For years, they’ve quietly kept patients healthier and out of the ER, kept costs down, kept communities strong — and gotten little recognition for any of it. Value-based care is the first real mechanism built to notice.