title: Implementation and Evaluation of the Safety Net Specialty Care Program in the Denver Metropolitan Area.
abstract: In response to limited access to specialty care in safety-net settings, an integrated delivery system and three safety-net organizations in the Denver, CO, metropolitan area launched a unique program in 2013. The program offers safety-net providers the option to electronically consult with specialists. Uninsured patients may be seen by specialists in office visits for a defined set of services. This article describes the program, identifies aspects that have worked well and areas that need improvement, and offers lessons learned.
  
  
  
  We quantified electronic consultations (e-consults) between safety-net clinicians and specialists, and face-to-face specialist visits between May 2013 and December 2014. We reviewed and categorized all e-consults from November and December 2014. In 2015, we interviewed 21 safety-net clinicians and staff, 12 specialists, and 10 patients, and conducted a thematic analysis to determine factors facilitating and limiting optimal program use.
  
  
  
  In the first 20 months of the program, safety-net clinicians at 23 clinics made 602 e-consults to specialists, and 81 patients received face-to-face specialist visits. Of 204 primary care clinicians, 103 made e-consults; 65 specialists participated in the program. Aspects facilitating program use were referral case managers' involvement and the use of clear, concise questions in e-consults. Key recommendations for process improvement were to promote an understanding of the different health care contexts, support provider-to-provider communication, facilitate hand-offs between settings, and clarify program scope.
  
  
  
  Participants perceived the program as responsive to their needs, yet opportunities exist for continued uptake and expansion. Communitywide efforts to assess and address needs remain important.
authors.affiliation: Research Assistant Professor in the Department of Health Systems, Management and Policy and the Centers for American Indian and Alaska Native Health at the University of Colorado Denver in Aurora. meredith.fort@ucdenver.edu.
authors.forename: Meredith P
authors.initials: MP
authors.lastname: Fort
authors.affiliation: Senior Community Health Specialist in the Community Benefit and Relations Department at Kaiser Permanente Colorado in Denver. lynnette.m.namba@kp.org.
authors.forename: Lynnette M
authors.initials: LM
authors.lastname: Namba
authors.affiliation: Community Health Center Advocate and a former Senior Manager in the Quality Initiatives Division of the Colorado Community Health Network in Denver. sdutcher@kentdenver.org.
authors.forename: Sarah
authors.initials: S
authors.lastname: Dutcher
authors.affiliation: Project Coordinator for Community Care in the Community Benefit and Relations Department at Kaiser Permanente Colorado in Denver. tracy.s.copeland@kp.org.
authors.forename: Tracy
authors.initials: T
authors.lastname: Copeland
authors.affiliation: Former Access to Care Manager in the Community Benefit and Relations Department at Kaiser Permanente Colorado in Denver. neysawb@yahoo.com.
authors.forename: Neysa
authors.initials: N
authors.lastname: Bermingham
authors.affiliation: Physician Lead for Safety Net Partnerships and Access to Care in the Community Benefit and Relations Department at Kaiser Permanente Colorado in Denver. christopher.j.fellenz@kp.org.
authors.forename: Chris
authors.initials: C
authors.lastname: Fellenz
authors.affiliation: Clinical Services Director for the Department of Neurology and Community Patient Access for Kaiser Permanente Colorado in Denver. deborah.j.lantz@kp.org.
authors.forename: Deborah
authors.initials: D
authors.lastname: Lantz
authors.affiliation: Cardiologist with the Colorado Permanente Medical Group in Denver. john.j.reusch@kp.org.
authors.forename: John J
authors.initials: JJ
authors.lastname: Reusch
authors.affiliation: Clinician Investigator for the Institute for Health Research of Kaiser Permanente Colorado in Denver and a Professor of Family Medicine at the University of Colorado School of Medicine. elizabeth.bayliss@kp.org.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Bayliss
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D019090:Case Management; D003120:Colorado; D003142:Communication; D003191:Comprehensive Health Care; D004581:Electronics; D005260:Female; D006296:Health Services; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D017057:Medically Uninsured; D008875:Middle Aged; D009819:Office Visits; D017060:Patient Satisfaction; D010820:Physicians; D015397:Program Evaluation; D012017:Referral and Consultation; D064876:Safety-net Providers; D013038:Specialization; D017216:Telemedicine