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

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



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.


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.


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).


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.


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.


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.


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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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.

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

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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).

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