Forum Session

Safety Net Integration: Tackling Fragmentation While Improving Access to Care and Efficiency
December 7, 2012


Jessamy Taylor, MPP


The lack of coordination across providers and settings in the U.S. health care system negatively affects health care costs, quality, and patient satisfaction. All providers face challenges with this, but primary care safety net providers, like federally qualified health centers (FQHCs), often struggle to gain access to specialty and inpatient care for their uninsured patients and many of their Medicaid patients. Becoming part of a more coordinated and integrated safety net system could help these providers improve access to care and the overall quality of that care and system efficiency. 

The Patient Protection and Affordable Care Act of 2010 (ACA) includes provisions to encourage delivery system integration including accountable care organizations, Medicaid health homes, Medicare avoidable hospital readmission penalties, and an FQHC patient-centered medical home demonstration for Medicare enrollees. While integration with other safety net providers holds promise for expanding access to care, improving care quality, and controlling costs, participation also comes with potential concerns and risks. This Forum session explored various types of integration among safety net providers, the challenges and opportunities of attaining it, and federal policies that may influence integration or fragmentation.


Katherine Neuhausen, MD (bio)
Robert Wood Johnson Foundation Clinical Scholar
Department of Family Medicine
University of California, Los Angeles

Jennifer DeCubellis, LPC (bio)
Area Director
Human Services and Public Health Department
Hennepin County (Minneapolis, Minnesota)

Leon Evans (bio)
President and Chief Executive Officer
The Center for Health Care Services (San Antonio, Texas)

Charles Alfero, MA (bio)
Executive Director
Hidalgo Medical Services – Center for Health Innovation (New Mexico)

Related Materials

Katherine Neuhausen et al., "Integrating Community Health Centers Into Organized Delivery Systems Can Improve Access to Subspecialty Care" (Health Affairs, 31, no. 8 (August 2012): pp. 1708–1716).

U.S. Government Accountability Office (GAO), "Health Care Delivery: Features of Integrated Systems Support Patient Care Strategies and Access to Care, but Systems Face Challenges" (GAO-11-49, November 16, 2010).

Katherine Witgert and Catherine Hess, "Including Safety-Net Providers in Integrated Delivery Systems: Issues and Options for Policymakers" (National Academy for State Health Policy, Issue Brief, pub 1617, vol. 20, August 2012).

Leighton Ku et al., "Promoting the Integration and Coordination of Safety-Net Health Care Providers Under Health Reform: Key Issues" (The Commonwealth Fund, Issue Brief, pub 1552, vol. 22, October 2011).

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