sb10069454ab-001We are in the midst of a national push for innovation to achieve the triple aim of better health, better health care, and lower per capita costs.  We can see positive results in many remarkable improvements being implemented by large health plans and health systems across the country.   We can also see promising innovation in experiments with payment systems designed to support better models of care.  There is much that can be learned and spread from these large-scale efforts.

There is another, less visible stream of innovation that has been flowing for decades just beneath the surface of the broader health landscape.  This stream of innovation is produced by safety net service providers operating in communities across the country.  These organizations provide care to millions of people who have significant health issues but limited or no ability to pay for services.  The safety net varies from community to community, but it typically includes community health centers, free clinics, community behavioral health organizations, essential hospitals, a spectrum of volunteer clinicians, and a variety of additional community service providers.

At Community Health Solutions we are fortunate to be able to work with a wide range of organizations, from large health plans and health systems to the smallest safety net providers.  Our observation is that many safety net providers have been practicing for years what we now call the core elements of patient-centered care.  Core elements such as patient engagement, self-management support, team care, integrated care, and clinical-community partnerships are not new to safety net organizations.   Also, safety net providers deliver these core elements for patient populations that have a high prevalence of chronic illness along with challenging economic circumstances.

Another observation is that many large health care organizations are struggling to implement these same elements of patient-centered care.  To be sure, there are legitimate reasons why some elements of patient-centered care are more challenging to implement in large organizations.  We should also note that safety net providers could learn much from leading health systems about managing the health of large patient populations.  The reality is that health care reform is challenging in every part of the system.  Perfection is not an option for anyone.

We should take advantage of opportunities to learn when we find them, and we do have an opportunity learn about patient-centered care from safety net providers.  One way to start  is with an informal meeting of local service providers to exchange information about the models of care being used in the safety net and other care settings within the community.  We have seen many of these conversations result in valuable learning for everyone involved, and even some new collaborations.  When health systems and safety net providers start exchanging insights and best practices, good things happen.


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