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90-day operational guide for FQHC executives launching a vision service line. Capital planning, OD recruitment, AI deployment, MCO credentialing, school MOU, and Year 1 launch metrics.
3 phases · 12 weekly milestones · 4 Year-1 targets · 5-item risk register
90
Days to launch
$900K+
Year 1 revenue target
3,000
Year 1 encounters
70%+
HEDIS EED target
Don't try to do everything Day 1. These are the four critical decision points.
Day 30
Capital approved + AI vendor selected + OD posted
Day 60
OD hired + equipment installed + MOU signed
Day 90
Live with 100+ patients + Year 1 dashboard active
Day 365
$900K+ PPS revenue + HEDIS EED ≥70% + Year 2 plan ready
Click each phase to expand. Every checklist item links to a primary source where applicable.
Week 1
CEO + CFO + CMO meet to align on the strategic argument: only 26% of FQHCs offer vision, 1 OD lane = ~$1M PPS revenue. Capital must come from non-Section-330 sources (vision is non-mandatory).
Week 2
Choose between LumineticsCore (Digital Diagnostics, 2018 first FDA AI), EyeArt (Eyenuk, 2020 broadest scope), AEYE-DS (AEYE Health, 2022 portable handheld). Each requires direct quote — none publish public pricing.
Week 3
Post OD job at $140-185K CA salary. Workforce headwind: optometrists are NOT NHSC-eligible (AOA lobbying via HR 920 / S. 1445). Use mission, FTCA coverage, and CA scope expansion (AB 407) as differentiators.
Week 4
Verify Medi-Cal MCO vision sub-vendor matrix (VSP, March Vision, Envolve, MES Vision). Each MCO contracts separately. Begin outreach to charity partners (VSP Eyes of Hope, Vision To Learn, Lions Eye Foundation).
Every FQHC vision launch hits these 5 risks. The mitigation column is what separates programs that succeed from programs that struggle.
OD recruitment failure due to NHSC ineligibility
Lead with mission + FTCA coverage + AB 407 scope expansion + total comp framing. Engage SCCO / UC Berkeley / Western alumni networks. Consider state SLRP. Advocate federally for HR 920 / S. 1445.
MCO sub-vendor billing complications
Build MCO-by-MCO sub-vendor matrix (VSP, March Vision, Envolve, MES Vision). Update quarterly. Alameda Alliance moved March Vision → VSP Jan 2026 — expect more reshuffling.
AI DR screening adoption gap
Embed in routine diabetes follow-up (not separate eye visit) per Cahaba Medical Care playbook. Train 4 MAs in 4 hours. Track screening completion rate weekly.
Dispensary capture rate below benchmark
Build bilingual flyer on Medi-Cal coverage timing. Train front desk to hand out at check-in. Reorganize frame inventory by coverage tier (pediatric / adult / private pay).
Pediatric pipeline conversion gap
Sign Vision To Learn MOU before launch. Build school nurse training on red-flag signs. Track pipeline: school screen → FQHC referral → completed exam.
Model your FQHC vision service line. All defaults from BLS, ACU 2023 FQHC survey, and DHCS APM guidance.
ACU 2023 FQHC survey: $155K avg, $168K rural, $151K urban
BLS OEWS May 2024: $59,960 CA mean
COA $52K, COT $63K typical CA median
$15-50K fundus camera, $40-100K OCT, dispensary, build-out
16 patients/day × 240 days = 3,840; ACU 2023 avg = 16.1/day
Medicare $195.99 base; CA Medi-Cal site rates often $300-$450
% of patients who order glasses on-site (40% benchmark)
$879,750
PPS margin: $663,750 + dispensary GP: $216,000
PPS Revenue
$1,080,000
3,600 × $300
Total Cost
$416,250
Labor + supplies + capital
Capital Payback
2.7 mo
$200,000 invested
Dispensary Revenue
$360,000
40% capture × $250
Sensitivity scenarios
Excludes optical lab COGS for Medi-Cal materials (separate billing line, not encounter-based) and excludes 340B savings on topical Rx. Includes ~$15K AI subscription estimate in supplies.
Walk through 4 questions to get a recommendation: LumineticsCore (Digital Diagnostics), EyeArt (Eyenuk), or AEYE-DS (AEYE Health).
Step 1/4 · Deployment model
Everything else you need to build the case, present to leadership, and start launching.
Vision Strategy
Inventory of 19 CA FQHC vision programs, charity partners, scope timeline
Case Studies
Cahaba 1-in-4 detection · San Ysidro DRES-POCAI · FHCSD 5-clinic · Alliance mobile
Vision OKR Template
Launch Vision Service Line — 6 KRs, $1M revenue target, downloadable Excel
4 Vision Masterclasses
PPS Revenue Lever · DR Screening Playbook · Glaucoma Equity · Kids' Vision Crisis
Vision Workplace Guides
6 guides: launch checklist, AI implementation, Medi-Cal billing, school MOU, farmworker vision, glaucoma protocol
Research Archive
11 vision entries: LALES, IDx-DR pivotal, Cahaba implementation, NACHC brief, ACU survey
Advocacy Actions
NHSC Improvement Act (HR 920 / S. 1445) · Medi-Cal $47 rate update
AI Tracker
LumineticsCore · EyeArt · AEYE-DS vendor cards with FQHC fit ratings