The Healthcare Partnership Nobody Is Talking About: Hospice + FQHCs | Part One

What if one of the biggest untapped opportunities for hospice growth, access, and community impact is a partnership most healthcare leaders aren’t even considering?

In Part One of The Healthcare Partnership Nobody Is Talking About: Hospice + FQHCs, Chris Comeaux sits down with Kyle Ahlenstorf, CEO of Infinity Health, to explore the powerful potential of partnerships between hospice and palliative care organizations and Federally Qualified Health Centers (FQHCs).

FQHCs are built around access, equity, and serving communities where barriers to healthcare are often greatest.  Kyle explains how these community health centers work, how they’re reimbursed, the populations they serve, and why their mission has so much in common with hospice and palliative care.

The conversation also explores integrated medical, dental, behavioral health, and pharmacy services—and how FQHCs can function as an important hub for coordinated, patient-centered care.

For hospice leaders, the opportunity goes far beyond generating another referral. Kyle and Chris discuss how trusted relationships, provider education, care coordination, and warm handoffs can create a stronger continuum of care for people facing serious illness.  Kyle also offers a highly practical starting point: find out who manages referrals at your local FQHC and begin building the relationship there.

In this episode, you’ll discover:

• What an FQHC is and why it matters to the healthcare safety net
• Why hospice and FQHC missions may be more closely aligned than leaders realize
• How FQHC reimbursement and payer mix work
• How FQHCs integrate medical, dental, behavioral health, and pharmacy services
• Why care coordination and warm handoffs matter for serious illness
• Common misconceptions hospice leaders may have about FQHC patients
• How hospice organizations can begin building relationships with local FQHCs
• Why behavioral health may represent another major area for collaboration

If you lead a hospice, palliative care organization, FQHC, community health center, nonprofit, or rural healthcare organization, this is a conversation worth bringing back to your leadership team.

👉 Your next step: Find the FQHCs serving your community.  Identify their referral or care coordination leader. Start a conversation about where your missions—and your patients—intersect.

Subscribe and turn on notifications so you don’t miss Part Two of this important conversation.

Guest:
Kyle Ahlenstorf, CEO of Infinity Health

Host:
Chris Comeaux, President / CEO of TELEIOS, author of The Anatomy of Leadership

The Anatomy of Leadership podcast explores the art and science of leadership through candid, insightful conversations with thought leaders, innovators, and change-makers from a variety of industries. Hosted by Chris Comeaux, each episode dives into the mindsets, habits, and strategies that empower leaders to thrive in complex, fast-changing environments. With topics ranging from organizational culture and emotional intelligence to navigating disruption and inspiring teams, the show blends real-world stories with practical takeaways. The goal is simple yet ambitious: to equip leaders at every level with the tools, perspectives, and inspiration they need to lead with vision, empathy, and impact.

https://www.teleioscn.org/anatomy-of-leadership

Transcript

Cause Driven Leadership Opening

Melody King 0:00

Everything rises and falls on leadership. The ability to lead well is fueled by living your cause and purpose. This podcast will equip you with the tools to do just that. Live and lead with cause and purpose. And now, author of the book The Anatomy of Leadership and our host, Chris Comeaux.

Meet Kyle And The Big Idea

Chris Comeaux 0:22

Hello and welcome. I'm so excited today. Our guest today is Kyle Ahlenstorf, who is the CEO of Infinity Health. Welcome, Kyle.

Kyle Ahlenstorf 0:30

Hi, Chris. Great to be with you today.

Chris Comeaux 0:32

Oh, it's good to have you, man. So let me introduce you to our audience. So Kyle is an MBA in OTRL. He serves as the Chief Executive Officer of Infinity Health, which is in Iowa. He brings more than a decade of healthcare experience spanning both clinical practice and executive leadership. Prior to joining Infinity Health, Kyle spent two years at Hoxie Medical Clinic in Northwestern Kansas, where he further developed his expertise in rural healthcare operations and strategic leadership. Kyle began his healthcare career as an occupational therapist practicing for nine years in predominantly rural settings. This clinical foundation provided him with firsthand insight into the unique challenges of rural communities, what they face, and also how they could access high-quality health care. And it shaped his commitment to advance sustainable patient-centered care models, which we're going to talk about today. Kyle earned a bachelor in science at kinesiology. Kinesiology. From Kansas State University, followed by a master's of occupational therapy from Nova Southeastern University. He also then to seek to expand his impact in healthcare leadership. Kyle then earned an MBA and with a concentration in healthcare administration from Avila University. Kyle's passion about strengthening rural healthcare systems through operational excellence, innovative partnerships, which is why we're talking today, and strategic advocacy. And he lives all of those things. His leadership is grounded in a deep understanding of both direct patient care and healthcare administration with a strong focus on ensuring rural communities have a voice in shaping healthcare policy at both the state and federal levels. At Infinity Health, he's committed to expanding access to comprehensive, high-quality care while building collaborative systems that support long-term care community health and organizational sustainability. All those are easy words for me to say. It's good to have you here, Kyle. And it's so cool to have you here because you're a good friend. And so I'm just so excited to introduce you to our hospice empowered care listening audience. Of course, we've got people kind of beyond that. You know, you and I kind of dreamed up this uh talk, this podcast, sitting around a campfire together. We attended two years in a row the elite leadership conference in Buena Vista, Colorado, which I just feel like now I could call you a good friend. So you know what my first question was going to be.

Vision And Connection As Leadership

Chris Comeaux 2:55

In fact, you said it's the hardest one I'm going to ask you today, which is what's your superpower?

Kyle Ahlenstorf 2:58

Yeah, and it's taken a little while to come up with that. Um and I I narrowed it down to a visionary. Um and I think you and I kind of talked about that even when we were out in Bonavista here here a couple months ago, of just that logistics and being able to look into the future. And that's um podcast that I listened to, John Maxwell, that's one of the things that he says makes a good leader and what sets leaders apart is seeing more than others see, and they see it before others see it. Um and being able to craft those logistics and the connections. And that was the other possible answer for for this question is being a connector. Um, and with that vision, being able to get those people in the room that need to be there. And even if you're not the one connected to the actual project or or the mission moving forward, making those connections to make that vision happen um with the people and the connections that you know.

Chris Comeaux 3:57

That is well said. And just to mirror it back to you, vision and connections. That's exactly why we're here together today, because as we were talking, number one, you're just you're a great guy and you're just so humble and makes me want to get to know you better. And the more I understood what you were doing with your F with your incredible FQH in Iowa, I was thinking, if I was a hospice CEO today, I would be thinking about my local FQH. And you just have a gift of like casting this vision of not only what you're doing, but where it could go. And I start to see these great connection points, and then I start to realize hey, I'm not going into any national conferences where someone's talking about what are you doing as a hospice and powder care organization with your local FQH? So that's really where the idea of today's podcast was born. And when we could uncover a frontier that I think very few people have thought about, not saying none have, but very few I feel have, um, to me, that would be a great conversation. So you ready to jump in? There are a lot of hospice and powder care leaders who listen, so they may not fully understand the safety net healthcare world. What exactly is an FQHC and why are these organizations becoming more and more important for serious illness healthcare, but also healthcare as a whole?

What An FQHC Is Made For

Kyle Ahlenstorf 5:09

Yeah. So just to go back to the beginning of the FQHC and Community Health Center movement, um, it actually started in the mid-1960s. Um, I think it was 1965 that Dr. Gibson and Dr. Gallagher actually got together and crafted the first two health centers in the way that they're actually formed. Um, one of them in Massachusetts, and then the other one down in Mississippi. Um, and in that, under the presidential guidance of President Johnson, um, health centers were funded under 330 funding through the HERSA department. So that overall is what has kind of guided and shaped um FGHCs over the last 50 years. Um so with the FGHC, the design was is to be able to provide services to patients that were either underserved or underinsured, um, and making sure that they had access to that. So, with that 330 funding that comes from the federal government, what FGHCs are designed to do is offer a sliding fee scale. So patients that are under 200% poverty are able to qualify for a discounted service, um, whether it's a medical service, a behavioral health service, a dental service, and even getting some of the prescription drugs that may be prescribed, they can get into what we offer as a slide fee scale and pay a nominal fee to gain access to that. Here at our location, if someone come in for a medical visit and they were under that 200%, they're a single individual or fit that first category, they could come in, they could get lab, they could get x-rays, and they could see a provider for as low as 20 bucks for that visit. And that would be their entire expenditure for that medical visit when they come in. So that would be kind of that initial introduction to what FQHCs and and how they're so beneficial to the communities that they're in.

Chris Comeaux 7:07

And it so it stands for federally qualified health centers. And is it a pretty not every community has an FQHC? Is it is there something about the population area that determines you probably would or wouldn't have one?

Kyle Ahlenstorf 7:20

Uh so so there's 1,400 um different organizations across US and US territories that are federally qualified health centers and also interchangeably talked about as community health centers as well. Um, but of those 1,400, they're all funded across multiple states. Here in Iowa, there's 14 different organizations that are FQHCs, kind of spread all throughout of Iowa. Um, and in each state, it's kind of different. Some metropolitan areas may have multiple um FQHCs inside of them. Um locations like Kansas City, uh Wichita, and Kansas, they have multiple even inside of those metro areas. Um, Wichita is a good example. They've actually got three FQHCs in Wichita, Kansas that work and serve different populations.

Chris Comeaux 8:13

You know, again, after we spent our time together in April, I got back and I got to go on site to one of our um hospice partners, and it's a very competitive market, and we've been having a hard time. And I asked them, like, do we know if there's an FQH? Well, sure enough there was, and guess what? We had not approached them and had not even thought about them. And we sat there and started doing research and then realizing, oh my gosh, this is a great potential partnership, which again is why I thought this would be a great show for folks. Well, many hospice eligible patients many times enter the healthcare system through FQHs. What does that mean for hospice and palliative care organizations in terms of thinking about access, equity, and community partnerships?

Access Equity And Rural Partnerships

Kyle Ahlenstorf 8:56

Yeah, and and that's a lot. Your access equity and community partnerships are really what the main mission and vision of most community health centers focus on is what's the access point for these patients to be able to get in? Do they have barriers or their communication or their funding? Um, other barriers that are limiting them to getting the services that they need. Um that access point is a main focus. And going back to the previous question of 330 funding, URSA puts out service area access points periodically to be able to develop and create new community health centers as time and funding is available. So that's a that's a great example of access. The equity involved, we're we're trying to get all patients to get the same service regardless of the payer source that they come in with. So that equity part, if you come in with Medicare, you come in with Medicaid, you come in with a private or commercial insurance, you should see the same level of quality care regardless of what that payer source is. That's we really talk heavily to our providers. Give the patients the care that they need. Don't worry about what the payment structure looks like and making sure that equal opportunity is there for patients regardless of what they need. Don't not run a lab because you think, well, their insurance may not cover it. If that's what you think is medically best for them, we as an organization will figure out how to financially cover that or make sure that it's built appropriately to make sure the patient gets the best care. And I think to the point of community partnerships, Chris, that's really what we're doing. And as Iowa rules out our rural health transformation, I was actually at a meeting this morning that we're looking at co-locations for services. And the minimum requirement is having three organizations that don't have duplicate services that are providing the needed care within one physical site. So when you're looking for community partners in each of the states across the US, should be receiving the money for the rural health transformation. Um $50 billion that was released by the US government to help rural communities be able to access and spread the care to additional resources. So that's one of those things that looking for these partnerships in those states really, really should help partner out of care, hospice, uh, community health centers, hospitals, all looking to work together to create a better system and care coordination for the patients.

Chris Comeaux 11:35

I love your answer. And this is actually one of the things that occurred to me. Again, I'm kind of sitting there and picturing us sitting around the campfire together in Colorado. And I remember when there was a point I looked at you and thought, you're our kind of people. And what I mean by that is hospice empowered care people over the years have just been, I joke and say they're like the marines of healthcare. Like, you know, basically, especially the nonprofit hospices, they accept people regardless of ability to pay. And they've created these amazingly transformative, innovative programs throughout the country, all from the standpoint of it doesn't matter the patients pay our source, we've taken care of them, and we've created these fascinating innovative models. And our tentacles and collaborations in the community are just incredible. And as a you were sitting there telling the story, I'm like, oh my God, you sound like a hospice-empowered care person, just in a different realm. And then, of course, me understanding more how you guys are reimbursed, which is maybe a good segue question, because I think it'll be helpful.

How FQHC Payment Actually Works

Chris Comeaux 12:27

So FQACs operate under a very different reimbursement model than hospitals, physician practices. Can you explain it? And is it called the PPS, the prospective payment system? Is that the right term?

Kyle Ahlenstorf 12:38

Um, and that's how we're reimbursed through Medicare and Medicaid. Um, and that's a predetermined rate that's paid, depending regardless of the service um that the patient comes in for. Medicaid patient comes in, they need an x-ray, they need labs, they need their annual physical, they also need a strep test. That's all going to be paid under that same PPS rate. So it's a fixed fee. They come in, that's the service that we're paid on, regardless of the services that are provided during that visit. In Iowa, we also, and I think hospitals also file a cost report, but it's very similar. In Iowa, that cost report, they've actually got a wrap system that at the end of each quarter, we're able to go back and create additional revenue through whatever the cost was actually incurred at the organization. Um, so that also creates some of that financial stability for community health centers and the FQHCs in our areas. Bioing that actually helps cover some of the expenditures, increase volume, decrease volume, especially in rural areas, that really helps create a sustainable revenue source for us as an organization to be able to provide those services.

Chris Comeaux 13:54

Is it inaccurate to say? So are you really a value-based payment type structure, or are you morphing and innovating into more of a value-based type structure?

Kyle Ahlenstorf 14:03

Uh so both. Um we participate, and and we might talk about that even a little bit later in one of your questions, is we are in Iowa Health Plus. Um, through our Iowa Primary Care Association, we actually, as network, have an ACO that we participate in. Um, and in that ACO, we've got contract with the managed care organizations within the state of Iowa to get some of those value-based care reimbursements at the end of the year and those shared savings. Um, there's a set of metrics that we're required to meet percentage-wise of the number of lives that are assigned to us of those managed care organization patients. And then as long as we're meeting those quality outcomes that will hopefully lessen the cost over the course of time for that patient, as long as they're getting the appropriate screenings and care that they need, those shared savings are given back to the organizations to continue to build that quality of care.

Chris Comeaux 15:03

And is it accurate, Kyle? This is the thing also that I've noticed in my own um where I live in Western North Carolina. I see that FQHC locally is getting innovative and they have um, I'll call them branches, the old days that maybe we would call them dock in the box, but just a place where you can go and get more of your primary care, multi-specialty care. So are FQHCs diversifying their pay remix? Like, you know, if my family had commercial insurance via me as an employer, could I go to my FQH and get my health care as a family?

Kyle Ahlenstorf 15:36

Yes. Um, and and that's one of those things that most community health centers want everybody to know. Sometimes when you get lumped into and people hear you're a safety net provider, they think, well, I've I've got resources, I've got commercial insurance. I shouldn't go there because that's going to take a spot. Um, actually, as a community health center, we value the Medicare, we value the commercial insurances because that allows us to extend some of those resources, especially financially, to be able to care for other patients that might not otherwise be able to afford the services that we're providing. Our federal grants are just a small percentage of our revenue stream that's coming in. So when we're able to create some additional margins on different insurance and payer types, that allows us to be able to do that expansion of services as well. So, yes, we we highly encourage people with commercial private insurances to also visit their community health centers. Just as we talked earlier, we shouldn't see a dip in the quality of care that those patients get just because they're coming to a community health center versus a private uh medical practice establishment. We we employ the same MDs, DOs, NPs, and PAs that they do. Um it's just the model in which that we're practicing and the delivery of care should patch and see the same as you would in any any of those other organizations.

Chris Comeaux 17:02

I would imagine just listening to you, number one, they're probably very purpose-oriented people. At a time when you go to healthcare and you feel like, man, my provider's treating me like a widget. I would imagine your people are much more purpose-centered, which again, when you and I are sitting there, I'm like, oh my God, did our culture sound similar? Is that an accurate statement as far as your people within your organization?

Kyle Ahlenstorf 17:24

Yeah. Um, and that and that's one of the things that we we talk about as an organization is our values. We have respect, we have integrity, we have a commitment, and our last value is excellence. And as long as we're following those, um, those are really what drive that patient experience. And and and it does take a little bit of a unique personality to want to work um in a safety net clinic. That's the patients are coming with probably more complex diagnosis and chronic conditions.

Chris Comeaux 17:59

Which means your people are very clinically competent. Not only they're purpose-centered, they're clinically competent.

Kyle Ahlenstorf 18:04

Yeah. And then that's probably one of the things that I applaud our providers with, is is they they deal with some of the people that have more complicated problems that other providers have either turned away or shunned, or or maybe not given enough attention to. Um, and that's one of the things that we talk as an organization, is we're focused on the outcome of the patient and we're meeting them where they are today to hope that they have a better future tomorrow. Um, and that and that's really what we're here for, is we are getting some of those patients that that may not have had access when we talk about our dental. Um, we probably do more extractions than we do fillings. Um, but the pain and the lack of sleep and the other additional healthcare complications that come with an abscess tooth or somebody that needs a root canal, they can't actually afford to get a root canal. If that extraction improves their quality of life, that's what we're here for, is to make sure that they've got a better future.

Chris Comeaux 19:06

We may have some hospital administrators listening, but when two hospital administrators walk up to each other and size each other up, one of the questions they ask is what's your payer mix? Um, hospice CEOs will say, What's your average daily census? Is it becoming as two FQHC CEOs meet each other? Is that one of your first questions? Is what's your payer mix or what's your total patient serve? What's one of those key metrics?

Kyle Ahlenstorf 19:29

Both of those, both of those are discussed. Um, the payer mix, kind of like we discussed that the less um uninsured patients, obviously that's going to help your your financial bottom line at the end of the day if you've got people coming in that are able to afford or bring insurance that increase those revenues for that visit. Um, but there there are different sizes of FQHC that's we as an organization see just shy of 50,000 encounters and just under 10,000 patients a year. There's organizations that see well over 100,000, 200,000 encounters and have 100,000 patients, um unique patients across the US and those FQHC organizations. So um at the end of the day, the mission is still to serve the patient, no matter the size, um, but it definitely makes an impact um on any additional ancillary services that are provided. Um, when we talk about care coordination and coupling of services, those that have a bigger spread on their payer mix or more divided payer mix usually have the ability to provide more services to offset those gaps in care for those patients that otherwise might not see.

Services Offered And Integrated Care

Chris Comeaux 20:46

You kind of alluded to this, but sounds so what I don't know if you talk about it this way, like the number of service lines that you have or service offerings. Can you go through kind of an inventory of those?

Kyle Ahlenstorf 20:56

Yeah, so here at Infinity Health, we offer medical, dental, behavioral health, and we also have an on-site pharmacy. Um, some others will get into even more specialized care. Um, in our behavioral health side, we offer counseling services through our therapists, we also offer SUD, and then we also offer um medication psychiatric services in our behavioral health. Um, but if you get into some of the larger FQHCs, you may see vision, um, you may see additional OB coverage that otherwise aren't always served at FQHCs. We try to partner with other organizations, local hospitals that cover some of those. Part of the HERSA requirements is there's a core number of services that you have to provide. Um, and those are typically your medical, dental, behavioral health, um, and some sort of pharmacy services. And those are categorized in three different columns that we have to meet at a HERSA level. So You can either provide those as an organization, you can partner with someone and bill for those services, or you can outsource those completely to a different organization to cover through written contracts and negotiations.

Chris Comeaux 22:14

You know, we always have our little thematic words in healthcare. Of course, we have a hell of a lot of abbreviations, but I noticed that medical-centered home was a term that was being thrown about quite a bit about three or four years ago. Is it accurate to say that an FQHC has a medical-centered home function to it?

Kyle Ahlenstorf 22:33

Yeah, and we are trying to revamp our patient-centered medical home format and making sure that it's more integrated across all of our services. That's we last quarter started back into our integrated care meetings more frequently and discussing actual patients that are identified in different disciplines and bringing that conversation together and say, hey, we we have this patient in the pharmacy, but we feel like they could use additional medical services. Or we see that they haven't been in to get their A1C, they're picking up their medications. But when was the last time that they saw one of our medical providers or the medical providers catching a screening that they come in for and hey, this patient may be on the verge of some depression, or they've got some anxiety and making that warm handoff to our behavioral health team to make sure that that care is coordinated. And I think that's one of the things when you talk about the partnerships and what palliative care and hospice do, it's that care coordination and having that trusted relationship of your service providers and our service providers communicating and making sure that transition is on a mutual level of trust when the patients are coming in. And that's what we see is when we have a good partnership and the trust is seen and we're talking each other up about organizations, that warm handoff when we're sending a service outside of here, the patients are always much more comfortable knowing that they're a trusted partner of ours. And I think that's something that could really be built between the palette of care and hospice and FGHCs is at the end of the day, that patient's going to need that service. And if there's already that trusted relationship, and we've talked about, hey, we've worked with this organization for many years. Many patients that we have seen have gotten that service from this organization. It just builds that camaraderie and that trust in the organization that, hey, I'm in good hands. They refer here frequently. There's a good partnership. We see the communication. And that to me is what really makes that patient feel special when they know that you're putting them in good hands.

Chris Comeaux 24:45

Well said. Well, that's like you anticipate my next question.

Partnering Myths And Referral Reality

Chris Comeaux 24:49

What do you think are some of the biggest misunderstandings that hospice leaders may have when trying to partner with FQHCs, especially around care coordination, referrals, funding?

Kyle Ahlenstorf 24:59

And I think one of the things that we talked about when you hear that safety net provider, some of the some of the concerns will be do these patients have financial ability to pay for these services? And in the care coordination, we try to find that as best as we can, especially for our Medicaid and Medicare services. We've got experts on our side that get them into the enrollment, make sure that they're in the right plans, make sure that they're getting the services that come along with that insurance pick that we help them find. So that side of things, don't be afraid of the patients that come from an FQH because you're afraid that, well, that's a safety net provider. There may not be any financial resources coming with that patient. Um that's just the myth that's out there that we're just a free clinic and we just hand services out every day. So the other thing is education. I'm not sure that our providers are familiar with what the palliative care and hospice industry offers, and making sure that that communication and education is provided directly to the medical team, the behavioral health team, the care coordinators in the community health centers. And that's just kind of a back and forth as to how do you have those integrated meetings across the organizations. That's I was fortunate enough earlier this month that you invited me to your guys' collaborative to discuss what what are behavioral health services offered at FQHC. And in that meeting, I learned more about how hospice and palliative care services are provided and kind of where those stages are at. And that helped preparing for this meeting is where do we need to build that relationship in those patients that we see that may have an illness that down the road they may need a palliative care, they may need some hospice services. When can we as providers start having that conversation and getting them in contact with the hospice organizations and say, here's the partner that we we work with? We know that eventually this is going to become something that you need and make sure that that relationship is built early. So I think a misunderstanding is that we only treat certain medical diagnoses and we're not looking for those referral sources. So that would be one of the things that I would definitely encourage is creating that care coordination and find out who's in charge of that referral within the organizations at FUHCs that are near you. Um we fortunately have a gal that does all our referrals in in and out. Um, and if I were an outsourced organization, she'd be the person here. If I was looking to build business, that's the first person I want to talk to. I wouldn't be looking for me, I'd be looking for our referral specialist.

Chris Comeaux 27:53

You know, and one thing for our listeners to connect the dots, what Kyle was alluding to, we we have uh we've done seven years of research. We've identified there are eight challenges facing every hospice and powder care program, and one of those is mental health. And some of our members have then taken off on that challenge and said, well, there's not a really good mental health care system in our country, and there's not one in our community, therefore, we need a behavioral health type competency or business or service line. And a couple of our members have launched that. Now, not every one of our members has the um, I would say time and the resources, and then to start realizing, well, wait a minute, FQHs have this very robust behavioral health component to what they do. Do we even know that in many of our communities? And one of the analogies we use is that mental health in our country, there's not really a system, and we even have a picture that goes with a challenge and it's a blanket with a bunch of holes in it. In other words, say it's like a patch quilt, but even that patch quilt has holes. But yet did many of these hospice leaders that are listening right now, did you know a good FQAT has got incredible behavioral health services? Which I want to maybe put that one on pause because I want to come back to that, because I wanted you to talk about that, but it didn't want them to miss that point that you just made about you know, if you learned a bunch by just sitting with us, and that was like what a 30-minute meeting, and you were educating our listeners about just what FQHC is.

Jeff Haffner 29:21

Don't miss part two of this episode coming this Friday.

Behavioral Health Link And Next Steps