Separate or United: The Safety Net in the Era of Health Care Integration

Rapid and significant transformation is occurring within the private sector of the health care system with consolidation, integration and the formation of new organizational structures such as Accountable Care Organizations. However, the safety-net systems upon which many patients rely, have remained largely in silos. To focus a spotlight on this issue at a community level we have compared the safety net in Alameda County, California and Denver, Colorado, the former with a safety net largely in silos and the latter an integrated safety net. We have discussed the policy implications and have delineated some of the levers that could be utilized to facilitate greater safety-net integration.