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Innovation in the Safety Net: Integrating Community Health Centers Through Accountable Care

Journal of General Internal Medicine volume 29, pages 1484–1490 (2014)Cite this article

A Capsule Commentary to this article was published on 05 August 2014

ABSTRACT

BACKGROUND

Safety net primary care providers, including as community health centers, have long been isolated from mainstream health care providers. Current delivery system reforms such as Accountable Care Organizations (ACOs) may either reinforce the isolation of these providers or may spur new integration of safety net providers.

OBJECTIVE

This study examines the extent of community health center involvement in ACOs, as well as how and why ACOs are partnering with these safety net primary care providers.

DESIGN

Mixed methods study pairing the cross-sectional National Survey of ACOs (conducted 2012 to 2013), followed by in-depth, qualitative interviews with a subset of ACOs that include community health centers (conducted 2013).

PARTICIPANTS

One hundred and seventy-three ACOs completed the National Survey of ACOs. Executives from 18 ACOs that include health centers participated in in-depth interviews, along with leadership at eight community health centers participating in ACOs.

MAIN MEASURES

Key survey measures include ACO organizational characteristics, care management and quality improvement capabilities. Qualitative interviews used a semi-structured interview guide. Interviews were recorded and transcribed, then coded for thematic content using NVivo software.

KEY RESULTS

Overall, 28% of ACOs include a community health center (CHC). ACOs with CHCs are similar to those without CHCs in organizational structure, care management and quality improvement capabilities. Qualitative results showed two major themes. First, ACOs with CHCs typically represent new relationships or formal partnerships between CHCs and other local health care providers. Second, CHCs are considered valued partners brought into ACOs to expand primary care capacity and expertise.

CONCLUSIONS

A substantial number of ACOs include CHCs. These results suggest that rather than reinforcing segmentation of safety net providers from the broader delivery system, the ACO model may lead to the integration of safety net primary care providers.

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Acknowledgements

We thank Savannah Bergquist, Kathleen Carluzzo, Tom Rundall, Aleen Saunders, Will Schpero, and Frances Wu for valuable contributions to and comments on earlier versions of this work. This work was supported by a grant from The Commonwealth Fund.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

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Authors and Affiliations

  1. The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, 35 Centerra Parkway, Lebanon, NH, 03766, USA

    Valerie A. Lewis PhD, Carrie H. Colla PhD, Karen E. Schoenherr BA & Elliott S. Fisher MD MPH

  2. School of Public Health and Haas School of Business, University of California, Berkeley, Berkeley, USA

    Stephen M. Shortell PhD MBA, MPH

Authors
  1. Valerie A. Lewis PhD
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  2. Carrie H. Colla PhD
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  3. Karen E. Schoenherr BA
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  4. Stephen M. Shortell PhD MBA, MPH
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  5. Elliott S. Fisher MD MPH
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Correspondence to Valerie A. Lewis PhD.

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Lewis, V.A., Colla, C.H., Schoenherr, K.E. et al. Innovation in the Safety Net: Integrating Community Health Centers Through Accountable Care. J GEN INTERN MED 29, 1484–1490 (2014). https://doi.org/10.1007/s11606-014-2911-0

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  • DOI: https://doi.org/10.1007/s11606-014-2911-0

KEY WORDS

  • health care reform
  • health care costs
  • health care delivery
  • underserved populations
  • safety net
  • accountable care
  • integrated care
  • community health centers