Beyond the Numbers: How FQHCs Can Use Financial Maturity Benchmarking to Drive Strategic Improvement
If you're a CFO or executive director of a Federally Qualified Health Center, you've probably asked yourself: "How do we really stack up against other health centers?" It's a deceptively simple question with profound implications. Are we investing in the right areas? Are our financial practices helping or hindering our mission? Where should we focus our limited resources to have the greatest impact?
As CLC consultant Terry Rehder observes, many health center clients can see their own financial data but lack context for how they compare to peers. Community Link Consulting's Financial Maturity Model addresses this gap by providing FQHCs with objective, comprehensive benchmarking that reveals not just where you stand, but which specific practices drive financial success.
The Challenge: Understanding Performance in Context
FQHCs operate in an increasingly complex environment where financial sustainability requires optimizing every operational lever available. The Health Resources and Services Administration's Performance Improvement Framework provided a foundation for self-assessment, but it stopped there. Health centers couldn't compare their practices against peers, couldn't see which specific improvements would yield the greatest return, and couldn't separate strong financial outcomes from the practices that actually drive them.
This distinction matters enormously. A health center might have strong cash reserves due to timing of federal grants but lack the underlying financial management practices to sustain that position. Conversely, another center might face temporary financial challenges despite having exceptional operational practices that position them for long-term success.
What Makes the CLC Approach Different
The CLC Financial Maturity Model addresses these gaps through a dual-lens approach that examines both qualitative practices and quantitative outcomes. The model evaluates 60 specific financial management practices across eight critical areas:
Core accounting
Financial planning and reporting
Performance management
Cash and accounts receivable management
Coding
Billing
Payer optimization
Pharmacy operations including 340B programs
Each practice area is assessed using a four-level maturity scale ranging from compliance-driven to strategic leading. The model provides structured, objective comparisons against peer performance, creating a clear roadmap for targeted improvement. As Amy Brisson, CLC's Chief Strategy Officer, explains, "The qualitative piece of this is so powerful to go along with the quantitative piece. A lot of times these types of comparisons are strictly quantitative, so I think ours is much more actionable."
Testing the Model: An Early Pilot with Promising Results
To validate the Financial Maturity Model's approach and refine the assessment process, CLC conducted a pilot program in late 2025 with nine participating FQHCs. These health centers represented diverse contexts:
Revenue ranging from $9 million to $92 million annually (six were between $13M-$15M)
Located across different states
Eight operating in Medicaid expansion states
A balance of urban and rural health centers
Important context: With only nine participants, these findings represent early directional insights rather than definitive conclusions. CLC recognizes the sample size is relatively small and is using the pilot to refine the analysis process. The goal is to expand to 20 or more participants to enable more robust comparisons and stronger statistical validity. The insights shared here should be viewed as preliminary findings that point toward promising patterns worth exploring as the dataset grows.
Early Insights: What the Pilot Revealed About Financial Success
Despite the small sample size, several compelling patterns emerged from the pilot data:
Practice maturity correlates with financial performance. With only one exception among the nine participants, health centers with more mature financial practices demonstrated better net operating margins. This validates what many have suspected but couldn't definitively prove: systematic, disciplined financial management practices directly contribute to organizational sustainability.
Two practices stand out as high-leverage improvement areas. Payer optimization and pharmacy management showed the strongest positive correlation with net operating margin. Health centers that excel in these areas don't wait for favorable conditions. They actively shape their payer mix, maintain rigorous insurance enrollment processes, stay ahead of PPS rate changes, and treat pharmacy operations as a strategic revenue diversification opportunity.
Common gaps emerged across participants. Coding practices and financial planning represented areas where most health centers saw room for growth. Many lacked formal coding staff training programs, productivity tracking beyond volume counts, and strategic financial planning that includes scenario modeling and capital planning beyond minimum requirements.
Using Maturity Benchmarking Strategically
The maturity model provides three critical capabilities:
1. Objective self-awareness. The model either confirms leadership instincts with data or reveals blind spots. One pilot participant believed their payer strategy needed significant work, only to discover they actually outperformed peers in payer mix favorability. This freed them to redirect resources to areas of genuine need.
2. Prioritization of improvement investments. Should you invest in new financial systems? Strengthen your coding team? Focus on contract negotiations? The assessment reveals which practice areas represent your greatest gaps and which areas show the strongest correlation to financial performance.
3. Accountability for improvement over time. The model isn't a one-time snapshot. By completing assessments annually, health centers can track whether improvement initiatives are actually driving practice maturity forward.
Questions to Consider Before Participating
For health centers considering a maturity assessment:
Who should be involved? The most accurate results come from engaging multiple perspectives: finance leadership, operational leaders, and program managers who understand specific functional areas. This reduces the risk of over- or under-estimating maturity.
What will you do with the results? The assessment is most valuable when leadership is genuinely prepared to use results in strategic planning and resource allocation decisions. Health centers that approach it as a learning opportunity rather than an evaluation gain the most value.
How will you ensure candid self-assessment? The model works best when health centers approach it with a growth mindset, recognizing that identifying current reality is the essential first step toward meaningful improvement.
Building a Stronger Sector Together
As the maturity model expands beyond the pilot phase, the opportunity for sector-wide learning grows. With larger sample sizes, comparisons can become more nuanced, allowing health centers to benchmark against organizations of similar size, geographic context, or patient population characteristics.
The maturity model supports the fundamental mission of FQHCs by helping them achieve financial sustainability that enables continued service to underserved communities. Financial strength isn't an end in itself. It's the foundation that allows health centers to expand services, weather economic uncertainties, invest in quality improvement, and ultimately serve more patients with greater consistency and care quality.
Moving from Questions to Answers
The question "How do we stack up?" no longer requires speculation or educated guessing. The Financial Maturity Model provides FQHCs with objective, actionable insights about both their current state and their path forward. Even with the preliminary nature of these early pilot findings, the patterns are clear: practices matter, specific operational strengths correlate with financial success, and health centers can identify and close their most critical gaps when armed with the right insights.
The path to financial excellence is systematic, measurable, and achievable with focused effort in the right areas. The question for your health center isn't whether to pursue improvement, but whether you have the insights necessary to pursue it strategically.
Expert Support Available
Community Link Consulting specializes in helping FQHCs strengthen financial management practices and achieve sustainable operations. Our Financial Maturity Model provides comprehensive benchmarking and actionable insights tailored to the unique challenges facing federally qualified health centers. We bring over 25 years of hands-on FQHC experience to support your improvement journey.
For information about participating in the Financial Maturity Model assessment or for strategic consultation on improving your financial management practices, contact us at:
Phone: 509-226-1393
Email: info@communitylinkconsulting.com
Strategic financial management support and maturity assessments available for FQHCs nationwide.
About the Authors:
Mike Wiser, Consultant - Brings extensive experience in FQHC financial analysis and strategic improvement initiatives. Mike led the development of CLC's Financial Maturity Model, combining analytical rigor with practical understanding of health center operations. Contact: mikew@communitylinkconsulting.com
Terry Rehder, Consultant - Former FQHC finance leader with deep expertise in operational assessment and financial management. Terry brings practical insights from years of hands-on health center experience to support meaningful improvement. Contact: terryr@communitylinkconsulting.com
Susan Robertson, Consultant - Specializes in performance analytics and reporting for healthcare organizations. Susan developed the comprehensive reporting framework that translates maturity assessment data into actionable strategic insights. Contact: susanr@communitylinkconsulting.com
Amy Brisson, Chief Strategy Officer - Combines over 15 years of progressive financial leadership experience with 11 years of specialized FQHC industry expertise to drive strategic initiatives and deliver solutions for community health centers. Her deep understanding of rural healthcare challenges and federal funding programs positions her as a trusted advisor for FQHCs navigating complex transformation initiatives. Contact: amyb@communitylinkconsulting.com
References:
Health Resources and Services Administration. (2024). Health Center Performance Improvement Framework: Financial Sustainability Domain. U.S. Department of Health and Human Services.
National Association of Community Health Centers. (2024). Community Health Center Chartbook. Washington, DC.
Community Link Consulting. (2025). Financial Maturity Model Pilot Study Results. [Internal Report]
