We've done any number of articles here at H&HN about the frailty of America's health care safety net. And with federal, state and municipal governments, as well as millions of individuals, struggling to cope with diminished finances, the outlook is hardly rosy.


So it was heartening to read about research from the Center for Studying Health System Change that found safety net clinics, hospitals and other providers are stepping up to the challenge of coordinating care for the nation's needy. Researchers found "a notable increase in efforts to improve the organization and delivery of care for uninsured and low-income patients" in 12 "nationally representative metropolitan communities." These include 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.

"Delivery of health services through the safety net historically has been fragmented," according to the study reported in the August edition of Health Affairs. "Usually hospitals, community healthy 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 costs to providers who typically operate with limited resources and thin margins."

Now safety net providers are adopting three main strategies to better coordinate their care:

  • Centralized referral networks provide an organized way for patients to receive referrals to physicians who will treat uninsured patients for free or at reduced cost.
  • Managed care for the uninsured initiatives connect patients with primary care providers in hopes of reducing emergency and inpatient care.
  • Care coordination involves multiple providers working together to, for example, establish a medical home for uninsured patients.

The study was funded by the Robert Wood Johnson Foundation and the National Institute for Health Care Reform.