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Improving Access to Health Care for Low-Income People

Ascension Health's Community Efforts to Foster Safety Net Collaboration; Implications for National Health Reform

News Release
July 7, 2011

Alwyn Cassil (202) 264-3484 or

WASHINGTON , DC—Communities that formally build collaborative health care safety nets can offer lessons for national health reform by offering roadmaps on how to improve access, reduce the use of unnecessary emergency and inpatient care, and improve people’s health, according to a qualitative study by the Center for Studying Health System Change (HSC) published in the July edition of Health Affairs.

Commissioned by Ascension Health, the study, titled “Improving Health Care Access for Low-Income People: Lessons from Ascension Health’s Community Collaboratives,” examined seven of the 28 communities that are working with Ascension Health’s five-step model to build collaborative safety nets. The communities—Austin, Texas; Milwaukee; Nashville, Tenn.; Pensacola, Fla.; Tawas City, Mich.; Troy, N.Y.; and Waco, Texas—were selected to represent a range of population sizes, geographic locations and progress.

Ascension Health, the nation’s largest Catholic and nonprofit health system, provides leadership and resources in each community and uses a five-step model to help communities develop needed infrastructure and services to better coordinate care for low-income people.

“The findings suggest that focused leadership and resources can foster collaboration among private and public health care providers, agencies, and others to improve coverage and access to care for low-income people,” said Laurie E. Felland, M.A., HSC director of qualitative research and coauthor of the study with HSC President Paul B. Ginsburg, Ph.D.; and Gretchen M. Kishbauch, a former HSC research assistant.

“National health reform places considerable attention on community efforts to improve the integration and coordination of care for low-income people, and the study findings indicate that collaborative safety net approaches can help improve access and reduce unnecessary care,” Ginsburg said.

Researchers conducted two-day site visits to each community between April and September 2009 to obtain multiple perspectives on safety net collaboration and strategies, drawing on interviews with 87 health care leaders, including executives from each community’s local Ascension Health hospital and other hospitals; community health centers; leaders of safety net collaborative groups or programs;  and others, such as representatives from consumer advocacy groups, local medical societies, health departments and local foundations. Researchers also spent a day at the Ascension Health system office in St. Louis.

The five-step model encompasses the following aims:

  • Develop communitywide formal infrastructure of main safety net providers and other organizations.
  • Fill service gaps, including prescription drugs and dental and mental health services.
  • Create care models to improve health outcomes for low-income, uninsured people by helping them navigate and use the health system appropriately.
  • Recruit private physician volunteers, working through hospitals and local medical societies.
  • Secure sustainable funding through public and private sources.

“Overall, the access and coverage goals and the five-step model aligned with the priorities of local safety-net leaders. The steps were considered broad and flexible enough to not be perceived as overly prescriptive but rather seen as providing guidance and a ‘push,’ accompanied by funds and other resources from Ascension Health (almost $3.3 million to the seven communities). The five steps generally matched types of actions that communities either wanted to pursue or had already started on a smaller scale,” according to the study.

Despite the successes, challenges remained in all of the communities to greater or lesser degrees, including provider competition, inadequate participation by clinicians, difficulties demonstrating impact and lack of sustainable funding.
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The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nation’s changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is affiliated with Mathematica Policy Research.

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Ascension Health ( is transforming healthcare by providing the highest quality care to all, with special attention to those who are poor and vulnerable. Ascension Health, which provided $1.1 billion in care of persons who are poor and community benefit last year, is the nation’s largest Catholic and nonprofit health system. Our Mission-focused Health Ministries employ 113,000 associates serving in more than 500 locations in 20 states and the District of Columbia.


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The Center for Studying Health System Change Ceased operation on Dec. 31, 2013.