New designation gives the agency a path toward broadening primary care services

In mid-December, officials with Prism Health North Texas announced that the agency has been designated as a "Federally Qualified Health Center Look-Alike," calling the designation a "significant milestone" marking "a crucial step in increasing access to high quality primary care services in North Texas, a community that continues to face challenges related to healthcare accessibility and adverse health outcomes."

But what exactly does that mean for an organization founded more than 38 years ago by the Community Council of Greater Dallas as AIDS Arms Network? Simply put, according to CEO Dr. John Carlo, better access to quality health care to communities that have been traditionally underserved, including the LGBTQ community.

Prism Health has "gotten very good at providing coordinated care over the last 38 years, but now we can expand that," Carlo said. "We know there are gaps in primary care, particularly in the LGBTQ community. Now we can fill those gaps."

While Prism Health already offered a broad spectrum of services, "particularly under the HIV care portfolio," he continued, "Now we can expand those services -- including dentistry, case management, mental healthcare and financial assistance -- to people not living with HIV. We can offer those services to people who are at risk of contracting HIV and to those not at any significant risk of contracting HIV."

In early 2017, officials at the agency announced the name change from AIDS Arms to Prism Health North Texas to better represent the agency's expanding services and broader target community. Two years later, in April 2019, Prism Health officials and the heads of Uptown Physicians Group announced that the UPG practice was merging into Prism, once again broadening Prism Health's reach.

Now the FQHC Look-Alike designation expands that reach even more.

"This has been a journey of some three-plus years," Carlo said, explaining that the FQHC Look-Alikes are FQHC organizations that meet the requirements of the Health Resources and Services Administration Health Center Program but do not receive additional federal funding.

"FQHCs are essentially HRSA's primary care sites that meet the standards for being a complete medical home [offering a wide range of primary care services], according to a strict set of criteria," Carlo said.

"You have to apply like a standard health center. You have to be compliant with all the policies and procedures as standard health center. You get the recognition of being a FHQC; you just don't get the grant funding."

FQHC grant money, he continued, is awarded nation-wide through a highly competitive application process, with grant awards based on "certain priorities the feds have established, and most of those priorities in recent years have been focused on rural health. That means that the competition among urban centers to get funding is stiff."

Now with its FQHC Look-Alike status established, Carlo said, Prism Health will commence the process of being certified as a standard FQHC clinic and the opportunity to throw its hat in the ring for some of those grant dollars.

But in the meantime, what advantages does the FQHC Look-Alike status offer? Plenty, Carlo said.

"Why go through two years of rigorous site reviews and so on to get this Look-Alike designation? What do you gain in the end? For one thing, as a Look-Alike, Medicare and Medicaid reimbursements are enhanced," he said.

"Primary care does not pay well for clinics treating those patients. Managed Medicare insurance doesn't pay well," Carlo continued. "But for FQHC Look-Alikes, those payments are enhanced. You get more money, and then you apply that money toward the services you offer, allowing you to expand those services and offer complete primary care including dentistry and case management and mental health and financial assistance.

"It's a much more robust system of providing care, particularly for lower income populations in the communities we serve," he said. "We've gotten very good at providing coordinated care, particularly under our HIV care portfolio. Now we can expand those services to the broader community."

There are significant gaps in primary care services, especially in the LGBTQ community, Carlo said. That means that many in the community are missing out on ways to maintain their overall health. For Prism Health, the FQHC Look-Alike designation means the agency can offer more patients an opportunity to not just get treatment for existing health issues but also to improve preventative healthcare efforts including preventing diabetes, high blood pressure, lung disorders, heart disease, obesity and more.

That is especially important in Dallas where the number of FQHCs is especially low.

"It's a big gap, and it's been around for a long time," Carlo said. "Parkland Hospital fills a lot of that gap, but Parkland has its benefits and its disadvantages. Not everyone wants to go to such a giant place for healthcare."

The only other standard FQHCs in Dallas are Los Barrios Unidos in West Dallas, Foremost Health in the MLK Center in South Dallas and Healing Hands Ministries near Presbyterian Hospital in North Dallas.

"This is a community of 2.3 million people, and four standard FQHCs is all we have," Carlo said.

"We intend to continue to grow," he continued. "One of the biggest unmet needs here is primary care for younger adults and for pediatric care. Of the children in Dallas, 90 percent are on Medicaid. That's a very large population without access to a medical home."

But Carlo stressed again that Prism Health's core mission of serving the LGBTQ and HIV communities remains steadfast.

"This whole process was mission-driven from the beginning," he said. "We never ever would move without the LGBTQ interest as our main, front-and-center focus.

"By broadening our approach, we are creating safer spaces for everybody," Carlo added.

"Not just growth but improvement. Doing this to make all of our services better. We have already improved, but this year we will see significant improvement for all of our patients."