By: Andrew Tarbox, MPH, Manager of National Strategy
At Community Care Cooperative (C3), we bring Federally Qualified Health Centers (FQHCs) together at scale to succeed in Value-Based Care (VBC). Through this model, FQHCs can stabilize their finances while reinvesting savings directly into the communities they serve.
Traditional Fee-for-Service (FFS) payment models reward volume rather than outcomes. Providers are reimbursed based on the number of visits or procedures delivered, which can lead to fragmented care. On the other hand, Value-Based Care (VBC) incentivizes clinical outcomes, quality metrics, and total cost of care. When providers are rewarded for improving health rather than increasing volume, they gain the flexibility to invest in quality improvement, team-based and preventive care.
VBC is often operationalized through Accountable Care Organizations (ACOs), where networks of providers take shared responsibility for the cost and quality of care for a defined patient population. When an ACO lowers the total cost of care while maintaining quality performance, providers share in the savings generated. Those savings can then be reinvested.
One long-standing program supporting ACOs is the Medicare Shared Savings Program (MSSP), created under the Patient Protection and Affordable Care Act to encourage providers to coordinate care for Medicare patients. Under this model, providers can share in savings if they reduce spending while meeting program quality standards.
Today, the program includes 511 ACOs serving 12.6 million beneficiaries across diverse settings, including hospitals, specialty and primary care practices, and FQHCs. MSSP has achieved notable success, generating more than $4.1 billion in shared savings as of 2024, the year with the most up-to-date data. Independent primary care-led ACOs consistently outperform ACOs led by other provider types. Analysis has also suggested that when ACOs include FQHCs they are more likely to achieve shared savings. FQHC participation in MSSP continues to grow steadily, from 4,409 sites in 2023 to 8,840 sites as of January 2026.
At C3, we have supported and remain committed to expanding FQHC participation in MSSP. Through two MSSP options, Track A (lowest risk, upside only) and MSSP Enhanced with Primary Care Flex (highest risk, upside and downside risk with capitation), C3 enables each FQHC to join an ACO according to its readiness. We maximize FQHCs’ ability to achieve shared savings and ensure FQHCs have meaningful and equal representation in ACO governance.
Since we began our Medicare ACO program in 2023, our Medicare ACOs have generated over $19 million in shared savings. FQHCs have reinvested these savings in what they do best: delivering preventive care, addressing social drivers of health, expanding community-based services and strengthening local partnerships.
