We Didn't Talk About Transformation — We Built It. Lessons from the FQHC Advanced Payment & Care Model

There was a moment in Oregon when “healthcare transformation” wasn’t a slogan — it was a living, breathing experiment. And it worked.

Long before CCOs were fully operational, there was a small team of people who believed something radically simple:

If you free people from the limits of fee-for-service and give them room to imagine, they’ll build the kind of care systems their communities actually need.

That idea became the FQHC Advanced Payment & Care Model — the first model in the nation to successfully pay Federally Qualified Health Centers a per-member, per-month rate not for more visits, but for health outcomes, access, prevention, and (my favorite) creativity.

It was the rare kind of policy work where everyone showed up willing to build instead of defend.

The Visionaries Who Made It Possible

At the Oregon Primary Care Association, leaders like Craig Hostetler, Laura Sisulak, Lauri Francis, and Curt Degenfelder weren’t asking for permission — they were asking for partnership. They knew something bold was needed, and they were willing to take risks on behalf of their clinics.

At the Oregon Health Authority, leaders like Don Ross and Judy Mohr Peterson did something too rare in public systems: they trusted their people. They didn’t micromanage innovation — they assigned ownership and protected the space needed to build it.

That’s how we ended up leading the operational and financial design of the model — everything from creating the PMPM payment mechanism in the state’s MMIS, to partnering with OPCA and clinical leaders to track new forms of care activity (or "touches" as we unfortunately called them) and impact.

There was no “pilot report” to hide behind. If something didn’t work, we fixed it in real time.That’s what transformation actually looks like when it’s alive.

The Clinics That Proved What’s Possible

What made the model real wasn’t the policy — it was the people delivering care.

FQHC leaders like Gil Muñoz and Dr. Laura Byerly (Virginia Garcia), Ken House and Megan Haase (Mosaic Medical), Erin Kirk and Mike Martin (OHSU Richmond Clinic) weren’t waiting for perfect conditions. They were co-architects of the model — helping shape the payment design, metrics, workflows, and lessons learned.

We weren’t lecturing clinics. We were learning with them — and building the system around what worked.

And the results? They weren’t theoretical:

• $17 million saved in the first 3 years across the first cohort

• FQHCs became the most advanced primary care homes in the state — 17% of clinics, but 35% of all Tier-5 STAR PCPCHs

• New forms of care emerged in place of volume-driven visits:

  • LCSWs proactively reaching out to prevent crisis

  • Teaching kitchens in food-insecure communities

  • Low-impact exercise classes built into the care team model

  • Integrated behavioral health and oral health access inside primary care

  • Population-based care panels replacing visit-churn survival

That wasn’t innovation for a conference stage. That was innovation measured in human lives, dignity, and access.

Why This Matters Now

The current culture around Oregon’s Coordinated Care Model feels foreign to me — not because I’m nostalgic, but because I’ve seen what’s possible when people actually collaborate with urgency and imagination.

What we built with the FQHC APCM wasn’t perfect — but it was alive. No one was hiding behind compliance requirements. No one was waiting 18 months for a steering committee sign-off. No one was asking “who owns this? ”Everyone was asking: “What does our community need next?”

Today, the statewide culture has shifted from experimentation to preservation. From iteration to risk management. From care design to contract protection. From “how do we improve this?” to “how do we not get in trouble?”

And that mindset is how systems collapse.

With the APCM collaborative, I didn’t learn how to write policy. I learned how to build systems with people who cared, people who were willing to move courageously into the new era.

As our Medicaid delivery systems come under attack and teeter on the edge of budget collapse, we need to be honest about what real leadership looks like that can guide us to the next era of health.