Strengthening California's Health Care Safety Net

Research to Strengthen California's Health Care Safety Net
and Prepare the State for Health Care Reform 

The University of California, Berkeley, University of California, Los Angeles, and University of California, San Francisco, working in partnership with researchers from The Philip R. Lee Institute for Health Policy at UCSF, released a collection of research briefs, targeted reports, and a clinic financial primer describing the impact of health care reform on providers serving low-income populations. Supported by a grant from the Blue Shield of California Foundation, research topics addressed by the University of California Health Care Safety Net Research Collaborative include:
  • Successful county strategies for developing safety net provider network for enrollees in county coverage initiatives;
  • The geographic distribution and health status of California's uninsured population after health care reform implementation;
  • The impact of health care reform on community clinic finances;
  • Best practices for using Health Information Exchanges (HIE) between safety net hospitals, community health centers, and physician practices.
Summaries and links to the individual reports are listed below. For more information about the UC Research Collaborative, please contact: Claire Brindis, Dr.PH at [email protected]
Updated! Maintaining Clinic Financial Stability:
Navigating Change, Leveraging Opportunities, June 2013

Annette Gardner, PhD, MPH

Maintaining Clinic Financial Stability: Navigating Change, Leveraging Opportunities

Philip R. Lee Institute for Health Policy Studies, UCSF.
June 2013 
California's community clinics and health centers are grappling with unprecedented change and huge
financial pressures. This primer describes the current funding environment and factors that are shaping
the future of California's clinics, including federal and state health care reform. Additionally, key strategies
for positioning clinics to thrive during this period of great uncertainty are discussed. The report can be
found at:

Achieving System Integration in California’s Health Care Safety Net.
Nadereh Pourat, PhD, Erin Salce, MPH, Anna C. Davis, MPH, and Diana Hilberman, PhD.
UCLA Center for Health Policy Research. Health Economics and Evaluation Research Program.
August 2012 
The efforts of ten California counties toward establishing a patient-centered health care system that provides access to coordinated and efficient care are described in an article and report by the UCLA Center for Health Policy Research. The article and report examine how effectively counties have transitioned from a fragmented safety-net model to an integrated health care network as part of the State of California’s Health Care Coverage Initiative (HCCI). The findings describe county advances in improving specialty access, quality of care, and health information technology.

The report can be found at:
The Health Affairs article can be found at:

After Millions of Californians Gain Health Coverage under the Affordable Care Act,
Who Will Remain Uninsured?
Laurel Lucia, Ken Jacobs, Miranda Dietz, Dave Graham-Squire, Nadereh Pourat,
and Dylan H. Roby.

UC Berkeley Center for Labor Research and Education and UCLA Center
for Health Policy Research.
September 2012.
The increase in coverage under the Affordable Care Act (ACA) will primarily result from the expansion of Medi-Cal and the availability of subsidized coverage in the California Health Benefit Exchange. However, three to four million Californians could remain uninsured even after the law is fully implemented. Using the California Simulation of Insurance Markets (CalSIM) model, researchers estimated the size and characteristics of the remaining uninsured under age 65 in California under two scenarios.

The Brief can be found at:
Health information exchange in California's public hospital systems:
Progress, obstacles, and opportunities. 
Robert H. Miller, PhD. Institute for Health & Aging,
University of California, San Francisco. 
The manuscript is being reviewed by a peer-reviewed journal.

The study describes health information exchange (HIE) activities in 10 of 12 of California's large public hospital systems and in two large University of California medical centers, including efforts to expand enterprise HIE capabilities and participation in regional (public, community) health information organizations. Systems with best practices in HIE with community health centers, including how HIE could support quality improvement efforts, are identified. Barriers to further HIE between public hospital systems and their medical trading partners and policy options that could overcome those barriers are described.