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Partnering to Succeed

How small health centers can improve care and thrive under value-based payment

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In California, community health centers (CHCs) serve more than four million people every year. Many CHCs are experimenting with strategies to improve and expand care, including finding ways to integrate behavioral health, bolster team-based care, and proactively reach out to patients with unmet preventive or chronic care needs. In tandem, health centers are increasingly participating in value-based payment. These actions require considerable infrastructure, with many components necessary for both endeavors.

All health centers struggle to put this infrastructure in place, but small health centers — defined for the purposes of this paper as having fewer than 10,000 patients or an annual budget of $10 million or less — face unique challenges in securing access to capital, building strong data capabilities, negotiating favorable rates with vendors, and securing contracts with health plans.

For small health centers, partnerships and alliances can be critical. When done well, these collaborations can help health centers fulfill their missions by supporting and supplementing primary care activities in ways that leverage resources and improve health.

Partnering to Succeed: How Small Health Centers Can Improve Care and Thrive Under Value-Based Payment (PDF) presents seven types of partnerships for small health centers:

  1. Partnerships with community-based agencies and organizations (local government and nonprofit)
  2. Partnerships with hospitals
  3. Consortia
  4. Management services organizations and clinically integrated networks
  5. Health center-led independent practice associations (IPAs)
  6. Partnerships with health plans
  7. Mergers and acquisitions

Individual small health centers may make use of one or many of these partnerships depending on an array of factors. This paper provides a detailed review of these factors, along with the advantages and disadvantages of each partnership type. In addition, four case studies highlight the experiences of small health centers partnering in these ways.

CEOs from two of the health centers featured as case studies share more in the videos below. Lori Holeman, CEO of Community Health Systems, Inc., discusses the benefits of joining a consortium while Ellen Silver, CEO of Parktree Community Health Center, discuss how joining forces with another clinic helped her organization better serve the entire community. Both women discuss why it’s important for CEOs of other small health centers to be open to partnership opportunities.

Join the conversation on social media using #PartnerToSucceed, and read a blog on this project by Rachel Tobey, director of John Snow, Inc. in California. The full report is available under Related Materials below.


The MacColl Center for Health Care Innovation at Kaiser Permanente Washington Health Research Institute
Katie Coleman, Clarissa Hsu, Heidi Berthoud, Brian Austin, and Ed Wagner

JSI Research & Training Institute, Inc.
Rachel Tobey, Kiely Houston, Jim Maxwell, and Sofia Rojasova

Leibig Shepherd LLC
Carolyn Shepherd

Qualis Health
Jeff Hummel





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