Integrating Health Care for the Most Vulnerable: Bridging the Differences in Organizational Cultures Between US Hospitals and Community Health Centers.
Policymakers have increasingly promoted health services integration to improve quality and efficiency. The US health care safety net, which comprises providers of health care to uninsured, Medicaid, and other vulnerable patients, remains a largely fragmented collection of providers. We interviewed leadership from safety net hospitals and community health centers in 5 US cities (Boston, MA; Denver, CO; Los Angeles, CA; Minneapolis, MN; and San Francisco, CA) throughout 2013 on their experiences with service integration. We identify conflicts in organizational mission, identity, and consumer orientation that have fostered reluctance to enter into collaborative arrangements. We describe how smaller scale initiatives, such as capitated model for targeted populations, health information exchange, and quality improvements led by health plans, can help bridge cultural differences to lay the groundwork for developing integrated care programs.
All of the authors are with the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco.
Michelle
M
Ko
All of the authors are with the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco.
Julia
J
Murphy
All of the authors are with the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco.
Andrew B
AB
Bindman
D003151:Community Health Centers / Q000458:organization & administration*; D006297:Health Services Accessibility / Q000458:organization & administration; D006739:Hospital Administration; D006801:Humans; D008484:Medicaid / Q000458:organization & administration; D017057:Medically Uninsured; D015279:Organizational Culture; D064876:Safety-net Providers / Q000458:organization & administration*; D018511:Systems Integration; D014481:United States; D035862:Vulnerable Populations