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Health Administration/Organization; Access to Health Care; Workforce Issues; Electronic Health Record; Government Funding; Health Homes; Managed Care


This report examines efforts to improve the coordination of health care among safety net providers in six communities (Austin, TX; Brooklyn, NY; Indianapolis, IN; Marshfield, WI; San Francisco, CA; and St. Louis, MO), based on case study site visits and a roundtable discussion. Across the communities, we identified three approaches to improving coordination: (1) collaboration of providers using a coordinating organization, (2) coordination facilitated by Medicaid managed care plans, and (3) development of highly integrated care systems. These represent models that could be used by different communities, based on their local circumstances. Successful development of coordination approaches involved shared commitment to a coordinated system and financing arrangements to support coordination. A key challenge was how to provide and support care, especially specialty care, for uninsured patients. A common trend across all the communities was the development of health information technology systems and movement toward patient-centered medical homes. At the time of this study, it was unclear whether the safety net providers in these communities would form accountable care organizations (ACOs), except for one which had already participated in a precursor to the ACO model.


Funder: The Commonwealth Fund.

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Health Policy Commons



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