Integrating Health Care for the Most Vulnerable: Bridging the Differences in Organizational Cultures Between US Hospitals and Community Health Centers

• DOI: 10.2105/ajph.2015.302931
• Publication Date: 2015-10-28T22:58:08Z
• Authors: Michelle Ko; Julia Murphy; Andrew B. Bindman
• Keywords: Biomedical and clinical sciences; 8.1 Organisation and delivery of services; No Poverty; Medical and Health Sciences; Vulnerable Populations; Health Services Accessibility; 03 medical and health sciences; 0302 clinical medicine; Hospital Administration; Clinical Research; Health Services and Systems; Health Sciences; Humans; Medically Uninsured; Medicaid; Health sciences; Community Health Centers; Health Services; Organizational Culture; United States; 3. Good health; Systems Integration; Good Health and Well Being; Patient Safety; Generic health relevance; Public Health; Safety-net Providers; Health and social care services research

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.