All ETDs from UAB

Advisory Committee Chair

Nancy Borkowski

Advisory Committee Members

Kristine R Hearld

Allyson Hall

Amy Landry

Seongwon Choi

Document Type


Date of Award


Degree Name by School

Executive Doctor of Science (DSc) School of Health Professions


Since the mid-1960s, Federally Qualified Health Centers (FQHCs) have been funded by the U.S. federal government to provide access to preventative and primary care for medically underserved communities. The federal government’s involvement in the funding of FQHCs was a response to extreme poverty, economic instability, and civil unrest related to the Civil Rights movement. Adoption of value-based care delivery practices to improve clinical and financial performances among FQHCs has been slow. This slow adoption has been attributable to cost, lack of expertise, and support. Since August 1994, the Department of Health Resources and Services Administration (HRSA), the funding source for FQHCs, has provided grants to support Health Center Controlled Networks (HCCNs) to address this issue. HCCNs assist FQHCs through health center collaboration, shared resources, and the adoption of practice management and Heath Information Technology (HIT) tools to increase participation in value-based care. Although many FQHCs have voluntarily affiliated with HCCNs, there is little known regarding the effectiveness of this strategic collaboration specifically for improving operational (i.e., financial) and clinical performance of FQHCs. The purpose of this study was to determine if there was an association between FQHCs with HCCN network affiliation and their reported clinical and financial performance as compared to FQHCs without an HCCN affiliation. We found that FQHCs with a HCCN affiliation report higher clinical and financial performances when compared to FQHCs with no HCCN affiliation. More specifically, six out of the seven adjusted clinical quartile rankings (AQRs) evaluated for free-standing HCCNs were more likely to be in the top / best 25% rankings however, only four were statically significant at p= .05. Also, four out of the seven AQRs evaluated for primary care association (PCA) HCCNs were more likely to be in the top / best 25% rankings however, only two were statically significant at p= .05. FQHCs affiliated with both free standing and PCA / HCCNs reported higher financial performance as compared to FQHC without an affiliation. The outcomes of this research are intended to inform healthcare leaders and policymakers regarding the effectiveness of this interorganizational collaboration.



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