Safety net clinics, hospitals and other providers that care for uninsured and low-income people increasingly are seeking ways to coordinate services to increase access, improve quality and reduce costs, according to a study by the Center for Studying Health System Change (HSC) published in the August edition of Health Affairs.
“Delivery of health services through the safety net historically has been fragmented. Usually hospitals, community health centers, and private physicians providing charity care have operated independently of each other, with little or no coordination.” Such fragmentation can result in severe gaps in the availability of services, reduce quality, lead to redundant use, and increase the costs to providers who typically operate with limited resources and thin margins,” according to the article by HSC Senior Fellow Peter J. Cunningham, Ph.D.; HSC Senior Researcher Laurie E. Felland, M.S.; and Lucy Stark, a former HSC research assistant.
Funded by the Robert Wood Johnson Foundation and the National Institute for Health Care Reform, the Health Affairs study is based on HSC’s 2010 site visits to 12 nationally representative metropolitan communities: Boston; Cleveland; Greenville/Spartanburg, S.C.; Indianapolis; Lansing, Mich.; Little Rock, Ark.; Miami; northern New Jersey; Orange County, Calif.; Phoenix; Seattle; and Syracuse, N.Y. HSC has been tracking change in these markets since 1996.
The study, titled “Safety-Net Providers in Some U.S. Communities Have Increasingly Embraced Coordinated Care Models” and available here, examined trends in safety net coordination activities from 2000 to 2010 in the 12 communities. Researchers found a notable increase in efforts to improve the organization and delivery of care for uninsured and low-income patients. The study identified three main approaches to safety net coordination: centralized referral networks, managed care programs for the uninsured, and care coordination across multiple providers:
Centralized referral networks focus on providing an organized way for patients to receive referrals to physicians—primarily specialists—who will treat uninsured patients for free or at reduced cost. Across the 12 communities, the number of centralized referral networks grew from zero in 2000 to four in 2010—Indianapolis, Little Rock, Orange County and Seattle.
Managed care for the uninsured initiatives focus on connecting uninsured patients with primary care providers in hopes of reducing emergency and inpatient care. The programs typically simulate a health plan, with people enrolling and receiving a membership card to access care. In 2000, Indianapolis and Boston operated these kinds of programs, and by 2010, Cleveland had one.
Care coordination across multiple providers involves organizations, such as a hospital and community health center, working together, for example, to establish a medical home for uninsured patients. Six of the 12 communities had these kinds of programs in 2010—Boston, Greenville/Spartanburg, Indianapolis, Lansing, Orange County and Phoenix—up from just two in 2000.
Community-based efforts to improve safety net coordination could provide a foundation for broader efforts to improve care delivery and expand coverage under national health reform, which encourages innovative payment and delivery models and potentially expands health coverage to more than 30 million Americans.
At the same time, some community respondents were “concerned that safety-net coordination programs could face a loss of private funding and community interest if the perception is that they are no longer needed due to greater access to affordable health insurance coverage, or if the perception is that the remaining uninsured are undeserving of coverage, for example, undocumented immigrants who are ineligible for coverage expansions under the Affordable Care Act,” the article states.