When your community health center opens its third, fifth, or twelfth location, it’s a milestone worth celebrating. But behind every expansion ribbon-cutting is a finance team silently bracing for the next wave of operational complexity.
Growth is good. But it can break things — especially outdated financial systems.
At too many Federally Qualified Health Centers (FQHCs), finance leaders are asked to scale operations, report accurately on federal funds, and support strategic decisions… all while using accounting tools that were never built for this level of complexity.
Let’s be clear: Legacy systems weren’t designed for multi-site, grant-funded, compliance-heavy healthcare organizations. And the cracks show fast as you grow.
This post explores the warning signs, the smarter path forward, and the real-life examples of two FQHCs — Wesley Community and Health Centers and Elica Health Centers — who made the switch before their systems cost them more than just time.
When Legacy Tools Hit Their Limits
It’s one thing to manage a single clinic with basic general ledger needs. It’s another when your FQHC is juggling:
- Dozens of funding streams with unique restrictions
- Site-specific reporting for HRSA and board oversight
- Uniform Data System (UDS) metrics, Schedule of Expenditures of Federal Awards (SEFA) audits, and grant-specific billing
- Hybrid teams and remote auditors who need clean, cloud-based access
And still, many clinics remain stuck with local-server software and manual Excel reconciliation. It’s not sustainable.
James Mohrherr, Controller at Elica Health Centers, saw this firsthand as the California-based FQHC grew from three to twelve clinics. “We were using Sage 50—it was clunky, on-premise, and we had outgrown it,” he said. “When the pandemic hit and we were all remote, the wheels really started to come off.”
Growth Without Financial Scalability Creates Risk
There’s a hidden cost to outgrowing your finance tools, and it’s not just inefficiency.
- Compliance risk increases when your system can’t track restricted funds or generate audit trails in seconds.
- Leadership blind spots deepen when you can’t access real-time financials for decision-making.
- Staff burnout escalates when financial reporting requires manual workarounds that never end.
At Wesley Community and Health Centers in Phoenix, Arizona, CFO Sonya Wilkins knew the organization’s growth — from a church-based clinic to a multi-site health system with mobile clinics and a new $20M facility — demanded a more flexible and scalable ERP solution.
“QuickBooks just wasn’t cutting it,” she said. “Trying to meet UDS reporting requirements and separate roles like nurse practitioners from doctors meant constantly adding accounts. It was messy and manual.”
Smart Finance Isn’t Just About Speed — It’s About Control
Modern FQHCs need more than a faster close (though Wesley did gain seven days back each month). They need control over their operations at scale.
Here’s what that looks like in action:
- Real-time visibility across grants, job codes, and locations
- Role-based access so program directors see only what matters to them
- Click-to-report audits that no longer require three-ring binders
- Scalable automation that keeps you lean even as you grow
When Wesley implemented Multiview, they built out Related Accounting Details (RADs) to tag financial data across dimensions. “We can now pull income statements by RADs, track FTEs for UDS, and generate reports that reconcile every time,” said Wilkins.
Elica saw similar improvements. “Now I can click and print instead of digging through binders,” said Mohrherr. “Multiview made it easy to track grant-specific revenue and expenses—without creating 50 different GL accounts.”
Key Trends Driving Smarter Finance in FQHCs
So what should CFOs at growing FQHCs be thinking about? Here are some best practices from health centers that have scaled successfully:
1. Automation, Not Just Efficiency
Automating reconciliations, grant billing, and audit prep frees up your team to focus on analysis, not data entry. And it reduces the risk of human error across high-stakes reporting.
2. Real-Time Financial Visibility
With delays in Medicaid reimbursements and ongoing board questions about program-level performance, FQHCs need live data — not month-old numbers.
3. Integration Across EHR and ERP
Integrating your Electronic Health Records system with your ERP can eliminate duplication and improve visibility for smarter decisions.
4. Cloud-Based Collaboration
Remote work isn’t going away — and neither are remote audits. A cloud-based ERP enables secure, permissioned access without waiting on IT or VPNs.
Challenging the Status Quo: Why “It Works for Now” May Be Holding You Back
Do these statements sound familiar?
“We’ll upgrade when things slow down.”
Reality: They won’t. And waiting often creates more tech debt and operational risk.
“Our current system gets the job done.”
Reality: If “the job” is late reporting, stressed audits, and burned-out staff, that’s not success, it’s survival.
“We can’t afford a new system.”
Reality: What’s the cost of delayed UDS submissions, clawbacks, or another audit finding? The ROI of modernization shows up fast - in saved time, fewer hires, and cleaner books.
Built for the Way FQHCs Work
Multiview isn’t a generic ERP system trying to fit into a healthcare box. It’s built, implemented and supported by a team that understands healthcare finance, giving FQHCs key capabilities that support:
- Fund and grant accounting
- UDS and SEFA compliance
- Site-specific and RAD-based reporting
- Departmental budgeting with role-based access
- Flexible growth — across locations, services, and funding models
Ready to Stop Patching Problems?
Scaling your FQHC shouldn’t mean stretching your finance team to the breaking point. You deserve systems that flex with your mission.
And as Sonya Wilkins from Wesley shared:
“Multiview probably saved us from needing another hire. We’ve automated so much. Our four-person finance team runs like a much larger department. We’re growing and need tools that grow with us. Multiview gives us that foundation—whether it’s managing grants or onboarding new locations.”
Final Thought: Scaling Smartly Starts with Systems
When the board approves a new site or program expansion, your team needs to respond with confidence — not duct tape.
Multiview ERP was purpose-built for this moment. For CFOs who are done patching problems, it’s the partner that lets you:
- Automate audit prep
- Eliminate spreadsheet chaos
- Meet compliance with confidence
- Empower decision-making with real-time visibility
It’s not just about better tools. It’s about better outcomes — for your team, your board, and the patients who count on you.
