ArticleMedical care2026
Impact of Alternative Payment Models on Quality of Care in Federally Qualified Health Centers From 2014 to 2024: A 2-stage Difference-in-Differences Analysis.
Article in Medical care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Abstract
backgroundFederally Qualified Health Centers (FQHCs) are essential safety-net providers, but traditional payment mechanisms may focus on volume over quality-of-care. Alternative payment models (APMs) have been introduced to enhance value-based purchasing. It is hypothesized that APMs would improve flexibility and incentivize quality of care, but evidence remains limited, especially for maternal and child health and cardiovascular conditions.
objectivesWe aim to evaluate the impact of APMs on quality-of-care in FQHCs in the United States.
methodsWe used a 2-stage difference-in-differences design to compare FQHCs in states adopting APMs with those that did not, using data from 2014 to 2024 in 695 FQHCs. Quality-of-care was measured using 6 indicators, including 2 associated with maternal and child services (early prenatal care and dental sealants), 2 with preventive care (depression screening and tobacco use screening), and 2 with cardiovascular disease management (cardiovascular and ischemic vascular disease treatment). To examine heterogeneity of the effects, the analysis stratified FQHCs into 3 groups based on patient volume.
resultsAPM adoption was significantly associated with improvements in 4 quality measures: a 3.82-percentage-point increase in early prenatal care, a 9.12 percentage point increase in dental sealants, a 5.08 percentage point increase in depression screening, and a 3.50 percentage point increase in ischemic vascular disease treatment. Stratified analyses showed that large FQHCs in APM-adopting states experienced statistically significant improvements in 3 indicators.
conclusionsOverall, APMs were associated with positive but modest improvements in quality-of-care at FQHCs.
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