March 24, 2026
As Medicare and the broader health care system shift from fee-for-service payment to value-based care, OCHIN is helping community health providers prepare for the transition to support long-term quality of care and financial sustainability.
Value-based care models reimburse health centers based on patient outcomes rather than the volume of services delivered. By prioritizing whole-person, high-quality care, these models aim to improve outcomes and lower costs—an increasingly important shift as community health centers face growing financial pressures, evolving regulatory requirements and increasing demand from older patients and those with more complex medical needs.
To help meet members where they are in their value-based care journey and to understand how best to support them through this transition, OCHIN partnered with the California Health Care Foundation on a statewide readiness assessment of California health centers. The evaluation sheds new light on where organizations are progressing in value-based care adoption, where additional support is needed for long-term success, and which strategies can strengthen strategic and operational readiness at community health centers.
A stronger future for community health centers
Within the OCHIN network, which serves over 7.9 million patients, 46% live with at least one chronic condition. Additionally, the number of Americans age 65 and older is projected to increase from 58 million in 2022 to 82 million in 2050. These trends highlight why community health centers need the tools and resources to navigate Medicare and manage increasingly complex care needs.
For over 25 years, OCHIN has worked alongside community health centers—whose patients often face higher risks for chronic conditions and barriers to accessing care—to ensure they have the support necessary to deliver high-quality, comprehensive care. Through our specialized, integrated EHR system and proactive consultative support, the OCHIN network has helped members achieve better outcomes for Medicare patients in areas such as chronic disease management, preventative screening rates and avoidable hospitalizations—performance gains that translate into greater overall savings for health care organizations.
While transitioning to value-based care requires new investments in care management infrastructure and in implementing best practices, it can drive meaningful care transformation and offer community health centers important opportunities to strengthen their financial sustainability while advancing their mission. By diversifying revenue streams through shared incentives, supporting preventative, whole-person care with team-based approaches that address medical and non-medical needs, and embedding measures that close gaps in care, value-based care can improve outcomes for rural and lower-resourced populations.
This experience has shaped a core belief: Value-based care can improve health outcomes and reduce costs, but only when community health organizations have the right infrastructure, data capabilities and workforce support in place.
This belief guides OCHIN’s partnerships with organizations such as the California Health Care Foundation and informs our efforts to help providers integrate evidence-based interventions, technology and whole-person care in ways that are both sustainable and responsive to community needs.
Partnering to understand readiness for value-based care
To better understand current capabilities and areas for improvement, OCHIN and the California Health Care Foundation conducted an assessment of 24 California community health centers in the OCHIN network to evaluate their readiness for value-based care.
The research team used a standardized tool that produced a readiness score for each participating health center and evaluated key areas such as data and reporting capabilities, billing workflows, staffing models and organizational processes. Interviews with health center providers added important context by giving them the opportunity to share their real-world experiences and challenges.
Key findings include:
- Readiness levels varied across organizations. The highest performing health centers participated in the Medicare Shared Savings Program or an accountable care organization, while those with lower readiness scores took part only in traditional Medicare or Medicare Advantage plans.
- Care coordination services were in place but underbilled. Many health centers offered services such as chronic care management, remote patient monitoring and transitional care management but were not consistently or effectively billing for the enhanced Medicare benefits associated with them.
- Health centers want more training. Nearly all organizations interviewed emphasized the importance of Medicare reimbursement and expressed a strong interest in more training and upskilling opportunities to strengthen staff knowledge.
- Health centers need reporting and data within an integrated platform. A unified, robust data and reporting platform is necessary to excel in both fee-for-service Medicare and value-based payment—enabling quality improvement, care gap identification and performance monitoring through strong partnerships, technology solutions and clear plans to optimize data infrastructure.
Consultative and technological solutions for value-based care adoption
The readiness assessment revealed several opportunities to further support community-based providers as they prepare for value-based care. For example, to help meet the needs of older patients and those with more complex medical needs—and to navigate rising regulatory and financial pressures—OCHIN has entered a new value-based care partnership with a fellow national nonprofit to strengthen care continuity and improve financial sustainability for health centers.
Through consultative guidance, workforce training and enhanced data and reporting infrastructure, OCHIN helps providers position themselves for long-term financial, operational and clinical sustainability.
Learn more
Read the full case study on the California Health Center Foundation’s website, and explore how OCHIN’s solutions and consultative support can help strengthen value-based care efforts.
