New Jersey federally qualified health centers: capacity building and sustainability under the Affordable Care Act

Primary healthcare is the foundation of the nation’s healthcare infrastructure. It is an essential component of advancing healthcare reform and better health outcomes for all. Federally Qualified Health Centers (FQHCs) constitute one of the largest networks of primary care providers both in New Jersey and across the nation. The Patient Protection and Affordable Care Act (ACA) has recognized that FQHCs are critical providers of primary healthcare to millions of uninsured and underinsured individuals. A significant body of literature suggests that FQHCs can exhibit strikingly different levels of readiness to function as sustainable providers, but there has been little research focusing on their capacity to adapt and meet the growing demands of the current healthcare environment. This qualitative study examined the capacity of New Jersey’s FQHCs to expand and sustain access to primary healthcare services. It also explored the impact of the ACA on FQHC capacity building in the state. In Phase 1 of the project, both the Brown et al. (2001), Conceptual Framework for Mapping Capacity and the results of a focus group of FQHC administrators, staff and clinicians, and other industry leaders were used to design a semi-structured interview guide. In Phase 2 of the project, twenty in-depth interviews were conducted with FQHC board members, administrators, clinicians and staff from a wide range of New Jersey FQHCs. Study participants reported different levels of FQHC readiness to respond to the ACA and varying levels of ability to engage in capacity building for enhanced organizational performance. Study findings also highlight how the contexts in which New Jersey FQHCs operate influence their approach to sustainability and the degree to which they engage in capacity building. Finally, the results of this study point to the need for research that examines the impact of public policy on capacity building in FQHCs nationwide. Ph.D.Includes bibliographical reference