Building Systems of Care in the Safety Net for High-Utilizing Patients

CHCF has provided funding for nine safety-net clinics to join a learning collaborative focused on improving care and reducing costs for high-risk, high-cost patients with complex medical and social needs.

March 2014

Health care spending is concentrated among a small population of patients who use a disproportionately large number of services. While early evidence shows that intensive primary care interventions, such as high-touch case management, reduce costs and improve outcomes for frequent users of care services, these interventions can be difficult to develop, staff, and sustain.

CHCF, in partnership with the Center for Care Innovations (CCI), will help nine safety-net clinics take part in a two-phase training and peer learning program that will teach organizations to develop and/or expand their own intensive primary care interventions. Following a competitive RFA process, the nine clinics selected for this project are:

  1. AltaMed Health Services Corporation
  2. CommuniCare Health Centers
  3. Golden Valley Health Centers
  4. Hope Center/Alameda County Health System
  5. Neighborhood Healthcare
  6. San Francisco Health Network
  7. Santa Rosa Community Health Centers
  8. St. John's Well Child and Family Center
  9. St. Vincent de Paul Village Family Health Centers

Phase 1 of the project, which began in March 2014, will focus on developing the clinics' measurement capacity, key partnerships, and change management processes. In Phase 2, participants will join a national learning collaborative, led by the Institute for Healthcare Improvement (IHI), to learn how to design sustainable systems of care for their specific high-risk, high-cost patient populations.

More information about this project is available on the CCI website through the External Link below.