Community Health Center Network

What Community Health Center Network does

Community Health Center Network (CHCN) is a non-profit Medi-Cal managed care organization founded in 1996 and headquartered in San Leandro, California. It operates a partnership model in which eight member Federally Qualified Health Centers — Asian Health Services, Axis Community Health, Bay Area Community Health, Baywell Health, La Clinica, LifeLong Medical Care, Native American Health Center, and Tiburcio Vasquez Health Center — jointly own and govern the network while retaining operational independence for patient-facing services. CHCN centralizes the administrative functions required to participate in Medi-Cal managed care: HMO contracting (notably with Alameda Alliance for Health), utilization management, claims adjudication, credentialing, prior authorization, provider dispute resolution, and quality improvement. The organization is responsible for approximately 200,000 Medi-Cal members across 135+ locations, with the broader member-FQHC network collectively serving 290,000+ patients at 140+ sites.

CHCN's product portfolio is anchored by managed care administration and extended by clinical and analytical products. Care Neighborhood Enhanced Case Management (ECM) operates under California's CalAIM waiver and is the largest ECM provider in Alameda County, deploying 55+ community health workers across all eight member FQHCs. Integrated Behavioral Health, eConsult (a virtual specialty consultation service powered by RubiconMD launched in 2023), and Data Analytics Services — built on OCHIN Epic, Tableau, SQL, and HIPAA-compliant EDI systems — together form the differentiated capability stack. A Skills Development Unit, partnered with UCSF's Pacific AIDS Education and Training Center, delivers training in trauma-informed care, harm reduction, and cultural humility.

Revenue derives principally from professional-risk capitation contracts with Alameda Alliance for Health for the managed care member population, supplemented by shared administrative services billed to member FQHCs. The organization is on a sliding-fee, capitation-based reimbursement model with member health centers, and Medicaid revenue is the single dominant payer source. CHCN has no external equity ownership, no subsidiaries, no acquisitions, and no funding rounds on record; it is a 501(c)-style safety-net infrastructure play that monetizes primarily through Medi-Cal capitation and member-allocated admin fees.

Name

Community Health Center Network

Legal name

Community Health Center Network

Website

https://chcnetwork.org

Company type

Private

Founded year

1996

Operating status

Operating

Headcount range

101–250 employees

Short description

Community Health Center Network (CHCN) is a non-profit Medi-Cal managed care organization that centralizes administrative and clinical support services for eight member Federally Qualified Health Centers serving approximately 200,000 Medicaid patients across the East Bay.

Ownership category

akta.pro rank

Product category

Managed Care Administration for Community Health Centers

NAICS

HMO Medical Centers (621491)

SIC

Services-Misc Health & Allied Services, Nec (8090), Services-Health Services (8000), Services-Membership Organizations (8600)

akta.pro primary industry

Group HMO Plans (FSAIAFAK)

Keywords

• Managed care administration
• Medi-Cal managed care
• Community health center services
• Enhanced case management
• Health insurance enrollment

Headquarters

HQ city

San Leandro

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Marketing or Sales, Others

Revenue model

1. Medi-Cal Managed Care Capitation: CHCN holds full professional risk managed care contracts with Alameda Alliance for Health on behalf of member health centers. The organization receives capitation payments for managing care of approximately 200,000 Medicaid patients, providing all managed care business functions including HMO contracting, utilization management, claims adjudication, and financial data reporting.
2. Administrative Services for Member Health Centers: Provides shared business administrative support services for eight community health centers including HMO contracting, primary care contracting, specialty care contracting, utilization management, membership reporting, quality improvement services, claims adjudication, centralized credentialing services, managed care IT services, and financial data reporting.

Go-to-market motion1 record

Distribution channels3 records

Marketing channels4 records

Core offering

CHCN is a non-profit Medi-Cal managed care organization that provides centralized business administrative support services for eight member community health centers in Alameda County. Its core offering is managed care administration including HMO contracting, utilization management, claims adjudication, capitation processing, and centralized credentialing. It extends this with Enhanced Case Management, Integrated Behavioral Health, eConsult specialty care, and Quality Improvement services.

Product overview

Community Health Center Network (CHCN) is a non-profit Medi-Cal managed care organization that functions as a partnership of eight community health centers in Alameda County, California. The organization provides a unified platform of business administrative support services designed to enable member FQHCs to focus on patient care. The core offering is managed care administration encompassing HMO contracting, claims processing, credentialing, and utilization management. This platform is extended by Care Neighborhood Enhanced Case Management (ECM) for intensive case management of high-risk patients, Integrated Behavioral Health for coordinated mental health and substance use services, eConsult for specialty care access via RubiconMD, Health Insurance Programs for Medi-Cal enrollment coordination, Data Analytics Services for clinical and operational insights, and Quality Improvement/Utilization Management Programs. Provider-facing services include Claims Processing, Electronic Data Interchange (EDI), Prior Authorization and Referral System, Provider Dispute Resolution, and Provider Credentialing. The Skills Development Unit provides training and technical assistance through a partnership with UCSF's Pacific AETC. CHCN serves approximately 200,000 Medi-Cal members across 135+ locations with 2,000 medical, dental, and mental health providers.

Differentiator

Problem solved

Functional benefit

Products and services

• Managed Care Administration Centralized managed care business functions for eight member FQHCs, including HMO contracting, primary and specialty care contracting, utilization management, membership reporting, quality improvement, claims adjudication, capitation processing, centralized credentialing, managed care IT, and financial data reporting under a full professional risk contract with Alameda Alliance for Health.
• Care Neighborhood Enhanced Case Management (ECM) Intensive case management program for high-risk, high-needs Medi-Cal patients connecting them to community resources and preventing unnecessary hospitalizations by addressing social determinants of health, delivered through Community Health Workers at the eight member FQHCs as part of California's CalAIM initiative.
• Integrated Behavioral Health Collaboration between primary care and behavioral healthcare at all eight member FQHCs, offering mental health promotion, treatment of mental and substance use disorders, trauma-informed care, recovery support, and ACEs screening and intervention.
• Health Insurance Programs Coordination of Medi-Cal and Group Care enrollment through Alameda Alliance for Health for patients of member health centers, providing business administrative support for member enrollment, eligibility, and benefits navigation, effective January 1, 2024.
• Data Analytics Services Business analytics reports delivering clinical data on patient hospitalization, pharmacy, and lab use to help health center leaders identify highest-need patients, flag potential health conditions, and support enrollment and re-enrollment to improve health access, quality, and outcomes.
• eConsult Electronic consultation platform enabling CHCN providers to obtain virtual specialty care input on diagnosis, treatment plans, medication regimens, and lab interpretation within hours through RubiconMD.
• Quality Improvement and Utilization Management Programs Comprehensive QI program monitoring, evaluating, and improving care within the network and UM program making fair, consistent utilization decisions through prospective, concurrent, and retrospective review under the clinical direction of the Chief Medical Officer.
• Provider Information Services Provider-facing services including claims submission guidance, referral and authorization processing, provider credentialing, HIPAA-compliant EDI for electronic transmission of membership, claims, and payment information, secure provider portal access, and the provider operations manual.
• Skills Development Unit Partnership between UCSF's Pacific AIDS Education and Training Center and CHCN providing training and technical assistance for Alameda County Care Connect on consumer engagement, cultural humility, de-escalation, harm reduction, social determinants of health, trauma-informed care, behavioral crisis services, primary care, public benefits, and substance use disorder services.
• Claims Processing Claims submission processing for providers including paper claim forms CMS-1500 (professional) and UB-04 (facility) and electronic claims via SFTP in HIPAA-compliant ANSI x12 5010x 837 formats, with paper claims acknowledged within 15 working days and electronic claims within 2 working days.
• Electronic Data Interchange (EDI) HIPAA-compliant electronic claims processing system accepting ANSI X12 formats including 837 Professional and Institutional claims submitted via secure SFTP, with a testing period required before production submission.
• Prior Authorization and Referral System Electronic fillable prior authorization and referral form system for CHCN Utilization Management staff including the Referral and Authorization Grid to determine services requiring prior authorization, with retro authorizations reviewed within 90 calendar days for Alameda Alliance for Health.
• Provider Dispute Resolution Written notice process enabling providers to challenge, appeal, or request reconsideration of denied, adjusted, or contested claims, and to dispute billing determinations and reimbursement requests for overpayments.
• Provider Credentialing Centralized credentialing services for medical providers through Alameda Alliance for Health handling initial and re-credentialing of clinic providers, contracting questions, contracted provider rosters, and access issue notifications.

Quantifiable outcome

• 200,000 Medi-Cal members served through managed care
• +4 more outcomes

Named customers9 records

Segments3 records

Ideal customer profiles3 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration5 records

Feature4 records

Partnerships

Six partnerships are on record, tiered core and supporting.

• Alameda Alliance for HealthcoreStrategic or Co-development PartnerAlameda Alliance for Health (AAH) is CHCN's health plan partner administering Medi-Cal and Group Care programs. Starting January 1, 2024, CHCN's Medi-Cal patients in Alameda County are assigned to Alameda Alliance for Health. The partnership provides comprehensive medical, vision, and dental benefits for managed care members.
• Alameda Health ConsortiumcoreStrategic or Co-development PartnerAlameda Health Consortium (AHC) is CHCN's sister organization. While the Consortium and Network operate as separate organizations, they play distinct roles and have complementary capabilities. AHC coordinates and implements programs and policies that ensure high-quality health care and decrease health disparities. Both organizations share offices at 101 Callan Avenue in San Leandro.
• UCSF Pacific AIDS Education and Training Center (Pacific AETC)coreStrategic or Co-development PartnerPacific AETC partnered with CHCN to form the Skills Development Unit, providing training and technical assistance for Alameda County Care Connect. Pacific AETC has 30 years of expertise in adult learning, training modalities, and community health, and is part of a national network covering all 50 states.
• RubiconMDcoreTechnology or IntegrationRubiconMD provides CHCN's eConsult platform enabling providers to access virtual specialty care for patients within hours. The platform allows providers to ask questions about diagnosis, gain insight on interim care plans, review medications, interpret lab results, and improve referral quality.
• OCHIN EpiccoreTechnology or IntegrationOCHIN Epic provides the electronic health record (EHR) system used by CHCN and member health centers. The Care Neighborhood ECM program has partnered with OCHIN Epic to create a specialized case management platform integrated in the EHR for patient tracking and care coordination.
• TableausupportingTechnology or IntegrationTableau data visualization program is used by CHCN's Care Neighborhood ECM to present program progress and impact. It pulls data from Epic to demonstrate growth over time and track progress with eligible populations at individual and programmatic levels.

Scale indicators6 records

Recent moves7 records

Expansion highlights5 records

Direct peers

• Alameda Alliance for Health: CHCN's sole health plan partner administering Medi-Cal managed care programs for ~200,000 CHCN patients in Alameda County; operates as the contractual counterparty for capitation and member enrollment, making it both customer and closest operational peer in California's Medi-Cal managed care ecosystem.
• Partnership HealthPlan of California: County-organized health system serving Medi-Cal members across 14 Northern California counties; structurally similar to CHCN's role as a community-anchored Medi-Cal managed care organization, with comparable responsibilities for FQHC network administration, ECM/quality programs, and utilization management.
• Central California Alliance for Health: Local, public Medi-Cal managed care plan serving Santa Cruz, Monterey, Merced, Mariposa, San Benito, and Stanislaus counties; operates a community health center-led model similar to CHCN's member-FQHC structure, with comparable capitation, ECM, and care coordination offerings.
• CalOptima: Public, community-based Medi-Cal managed care plan serving Orange County; comparable county-organized health system with similar member composition, FQHC partnerships, ECM delivery, and value-based care programs that overlap directly with CHCN's model.
• Inland Empire Health Plan (IEHP): One of the largest not-for-profit Medi-Cal and Medicare-Medicaid plans in California, serving Riverside and San Bernardino counties; similar mission-driven, FQHC-partnered managed care model, with comparable ECM, CalAIM, and population health management offerings.
• Health Plan of San Mateo: Locally controlled Medi-Cal managed care plan serving San Mateo County with strong FQHC integration; comparable in scale, governance model (community-owned), and CalAIM/ECM operating model to CHCN.

Broad incumbents

• L.A. Care Health Plan: Largest publicly operated Medi-Cal managed care plan in the U.S., serving Los Angeles County; broader in scale and scope than CHCN, but uses a comparable network of community clinics and delegated managed care arrangements to deliver Medi-Cal services, with extensive ECM and care management programs.

Emerging players

• Aledade: National physician- and FQHC-focused ACO and value-based care enablement company; comparable in supporting safety-net providers to participate in managed care and risk-bearing arrangements, including Medicaid and Medicare ACO programs; partial overlap with CHCN's data and care coordination capabilities.

Others

• OCHIN: National nonprofit health IT organization providing the Epic EHR instance used by CHCN and its member FQHCs; adjacent as a critical infrastructure provider enabling CHCN's integrated EHR, ECM platform, and clinical data analytics capabilities.
• RubiconMD: eConsult platform powering CHCN's virtual specialty care program since 2023; adjacent technology partner enabling rapid specialist access for FQHC patients and a comparable use case for community health providers nationwide.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights6 records

Customer concentration

• Xtwitter.com/ACHealthCenters
• YouTubeyoutube.com/user/alamedahealthconsort
• Facebookfacebook.com/alamedahealthconsortium
• LinkedInlinkedin.com/company/community-health-center-network
• Instagraminstagram.com/alamedahealthconsortium

Compliance5 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles6 records

Funding overview

Funding rounds1 record

Investors1 record

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Community Health Center Network